Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 11722081-1204 | UT |
NPI | 1003231952 |
---|---|
Provider Name | Jacoby Jacobsen |
First Address | Toledo, OH 43608-2603 |
Second Address | Toledo, OH 43608-2603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2014 |
Last Update Date | 21/10/2021 |