Individual
TYSON R JAKOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
600 N ROBBINS RD, #401, BOISE, ID 83702-4565
(208) 383-0201
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PEND
ID
Other
Enumeration date
12/10/2012
Last updated
12/10/2012
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