Dr. Dale Gary Jacobson, MD
Family Medicine in Walworth, WI. Individual provider (NPI-1).
NPI number1346357860
StatusActive
Last updated in NPPESMar 7, 2023
Details
- NPI
- 1346357860
- Entity type
- Individual (NPI-1)
- Name
- Dr. Dale Gary Jacobson
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 23, 2006
- Last updated
- Mar 7, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 23975 | WI | Yes |
Practice location
525 Kenosha St#a
Walworth, WI 53184
Phone 262-275-2101 · Fax 262-275-0752
Mailing address
3301 W Forest Home AveMilwaukee, WI 53215-2843
Phone 414-647-6326 · Fax 414-671-8860
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