Jacobson, Dale Gary
Jacobson, Dale Gary is an individual health care provider with primary practice located at 525 Kenosha St #A, Walworth WI 53184. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Jacobson, Dale Gary can be contacted via phone (262) 275-2101.Contact Information
Primary practice address
525 Kenosha St #A
Walworth WI 53184
Phone: (262) 275-2101
Fax: (262) 275-0752
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 23975 | Wisconsin |
Profile Details
| NPI number | 1346357860 |
|---|---|
| LBN Legal business name | Jacobson, Dale Gary |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 23rd, 2006 |
| Last updated | Mar 7th, 2023 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1346357860 | NPPES |
| Wisconsin | MEDICAID | 30394600 |
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