Individual
LANCE GLEN JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3200 CHANNING WAY STE A205, IDAHO FALLS, ID 83404-7586
(208) 535-4580
Mailing address
PO BOX 277381, ATLANTA, GA 30384-7381
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M-14018
ID
207XX0801X
Orthopaedic Trauma Physician
M-14018
ID
Other
Enumeration date
03/26/2012
Last updated
09/14/2023
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