Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 3822 | ND |
NPI | 1073712469 |
---|---|
Provider Name | Severt H Jacobson |
First Address | Bismarck, ND 58506-5501 |
Second Address | Bismarck, ND 58501-4436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2007 |
Last Update Date | 23/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17365 | (05) | ND |
C80975 | (02) |