Individual
JUSTIN A. JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2831 FORT MISSOULA ROAD, SUITE 232, MISSOULA, MT 59804
(406) 728-6101
(406) 721-3278
Mailing address
2831 FORT MISSOULA ROAD, SUITE 232, MISSOULA, MT 59804
(406) 728-6101
(406) 721-3278
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
104281
MN
207X00000X
Orthopaedic Surgery Physician
Primary
12306
MT
207X00000X
Orthopaedic Surgery Physician
52250
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157857219
—
MT
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
Enumeration date
08/05/2006
Last updated
01/30/2012
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