Individual
JACOB MICHAEL POULSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1842 E ELM, TUCSON, AZ 85724-0001
(520) 626-7233
Mailing address
8206 N WHEATFIELD DR, TUCSON, AZ 85741-1258
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
81900
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81900
ARIZONA MEDICAL BOARD
AZ
Enumeration date
07/26/2007
Last updated
07/26/2007
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