MEDICARE: RADU JACOB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	ME89216	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265462873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RADU JACOB MD

Provider Business Mailing Address
First Line	:	8130 ROYAL PALM BLVD
Second Line	:	SUITE 102
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-5703
Country	:	US
Telephone Number	:	954-345-4333
Fax Number	:	954-345-4334

Provider Business Practice Location Address
First Line	:	8130 ROYAL PALM BLVD
Second Line	:	SUITE 102
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-5703
Country	:	US
Telephone Number	:	954-345-4333
Fax Number	:	954-345-4334

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	11/20/2008

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Directions to “ RADU JACOB MD” Practice Location

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