Provider Demographics
NPI:1730184201
Name:JACOBSON, SCOTT R (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 NE NEFF RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4283
Mailing Address - Country:US
Mailing Address - Phone:541-382-3344
Mailing Address - Fax:541-382-1681
Practice Address - Street 1:2200 NE NEFF RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4283
Practice Address - Country:US
Practice Address - Phone:541-382-3344
Practice Address - Fax:541-382-1681
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19419207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD19419OtherDBME
OR074067Medicaid
ORMD19419OtherDBME
OR074067Medicaid