Active NPI
Hart Jacobsen, M.D.
- Otolaryngology Physician
- Lander, WY
National Provider Identifier
1487980017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 2675A
- Practice address
- 30 Pheasant Run Dr
Lander, WY 82520-9783 - Phone
- (307) 332-3115
- NPI assigned
- Nov 3, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 2675A | WY | Primary |
Addresses
Primary practice location
30 Pheasant Run Dr
Lander, WY 82520-9783
Mailing address
30 Pheasant Run Dr
Lander, WY 82520-9783
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2675A | WY | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1257206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257206400000",
"number": "1487980017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 PHEASANT RUN DR",
"city": "LANDER",
"state": "WY",
"postal_code": "825209783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 PHEASANT RUN DR",
"city": "LANDER",
"state": "WY",
"postal_code": "825209783",
"telephone_number": "307-332-3115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBSEN",
"first_name": "HART",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-11-03",
"last_updated": "2009-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "WY",
"license": "2675A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lander, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.