Provider Demographics
NPI:1427102938
Name:JACOBSEN, CHER A (MD)
Entity type:Individual
Prefix:DR
First Name:CHER
Middle Name:A
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 W 4TH AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4979
Mailing Address - Country:US
Mailing Address - Phone:208-773-1593
Mailing Address - Fax:
Practice Address - Street 1:185 W 4TH AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4979
Practice Address - Country:US
Practice Address - Phone:208-773-1593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8065757Medicaid
IDP00027582OtherRAILROAD MEDICARE
ID000010142829OtherREGENCE
ID53223OtherBLUE CROSS
IDP00027582OtherRAILROAD MEDICARE
ID8065757Medicaid