Individual
PAUL KENNETH JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
924 1ST ST NE, FARIBAULT, MN 55021-5441
(507) 333-3207
(507) 333-3302
Mailing address
924 1ST ST NE, FARIBAULT, MN 55021-5441
(507) 333-3207
(507) 333-3302
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27605
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080169214
MEDICARE RAILROAD
MN
05
—
958767500
—
MN
Enumeration date
12/21/2005
Last updated
03/25/2009
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