Provider Demographics
NPI:1962623447
Name:JACOBSON, BRENT R (DO)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:R
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:13737 NOEL RD STE 1600
Mailing Address - Street 2:ATTN: RAYS
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-1374
Mailing Address - Country:US
Mailing Address - Phone:303-933-8270
Mailing Address - Fax:214-712-2002
Practice Address - Street 1:8647 COACHLIGHT WAY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80125-9651
Practice Address - Country:US
Practice Address - Phone:303-933-8270
Practice Address - Fax:214-712-2002
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2013-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL125-0519802085R0202X
IA41762085R0202X
CODR-509452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology