Individual
DR. RANDALL K. JACOBSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
427 S BERNARD ST, SPOKANE, WA 99204-2509
(509) 456-0107
(509) 747-2635
Mailing address
427 S BERNARD ST, SPOKANE, WA 99204-2509
(509) 456-0107
(509) 747-2635
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD00036964
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005537
ASURIS(REGENCE BS OF ID)
ID
01
—
125850
LABOR AND INDUSTRIES
WA
01
—
17297
GROUP HEALTH
WA
05
—
8239758
—
WA
01
—
A025
TRICARE
WA
01
—
JA7856
ASURIS(REGENCE NW HEALTH)
WA
01
—
KM646
BLUE CROSS OF ID
ID
01
—
WA0690
NORTHWEST BENEFIT NETWORK
WA
Enumeration date
07/12/2005
Last updated
07/08/2007
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