Individual
TREVOR DEAN JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
166 S 5TH ST, MONTPELIER, ID 83254-4959
(208) 847-1110
(208) 847-0228
Mailing address
PO BOX 69, MONTPELIER, ID 83254-0069
(208) 847-1110
(208) 847-0228
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-12665
ID
Other
Enumeration date
05/28/2009
Last updated
12/11/2014
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