Provider Demographics
NPI:1902969090
Name:FASSMAN, JACOB DANIEL (DPM)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:DANIEL
Last Name:FASSMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:455 E PIKES PEAK AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3673
Mailing Address - Country:US
Mailing Address - Phone:719-475-8080
Mailing Address - Fax:719-475-0913
Practice Address - Street 1:455 E PIKES PEAK AVE STE 220
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3673
Practice Address - Country:US
Practice Address - Phone:719-475-8080
Practice Address - Fax:719-475-0913
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPOD0000793213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery