Individual
GARY A JACOBSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6327 SW CAPITOL HWY. , SUITE C, PMB 211, PORTLAND, OR 97239
(503) 245-1274
Mailing address
6327 SW CAPITOL HWY. , SUITE C, PMB 211, PORTLAND, OR 97239
(503) 245-1274
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MC08382
OR
Other
Enumeration date
04/20/2009
Last updated
04/20/2009
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