Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 00047437 | WA |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 01074807A | IN |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 16723 | HI |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 2011011924 | MO |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 258455 | NY |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 27129 | NE |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 68921 | GA |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 7805936-1205 | UT |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | M-11174 | ID |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD15777 | OR |
NPI | 1033291323 |
---|---|
Provider Name | Sig-Linda Jacobson |
First Address | Portland, OR 97221-1835 |
Second Address | Portland, OR 97221-1835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 21/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0085221 | (05) | MT |
027094 | (05) | OR |
160055377 | RAILROAD MEDICARE (01) | OR |
300050370 | (05) | IN |
807008800 | (05) | ID |
8201691 | (05) | WA |
93125743797239E020 | TRIWEST (01) | OR |
E20636 | (02) | OR |
IN1776461 | MCR (01) | IN |
MD2637R | (05) | AK |