Provider Demographics
NPI:1841452919
Name:JACOBSON, JEFFREY ERIC (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ERIC
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-247-4240
Mailing Address - Fax:515-247-4239
Practice Address - Street 1:1111 6TH AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-2613
Practice Address - Country:US
Practice Address - Phone:515-247-4240
Practice Address - Fax:515-247-4239
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN569282084P0800X
PAOS0179072084P0800X
PAMT2003092084P0800X
IADO-063952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04358389Medicaid
PA1030976690001Medicaid
PA466163N3FMedicare PIN