MEDICARE: DR. IRA JOEL JACOBSON DPM

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	213E00000X	Podiatrist	P00001689	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03288	OTHER	FL	WELLCARE ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427030659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRA JOEL JACOBSON DPM

Provider Business Mailing Address
First Line	:	7431-33 WEST ATLANTIC AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-3505
Country	:	US
Telephone Number	:	561-496-6900
Fax Number	:	561-496-5348

Provider Business Practice Location Address
First Line	:	7431-33 WEST ATLANTIC AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-3505
Country	:	US
Telephone Number	:	561-496-6900
Fax Number	:	561-496-5348

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	03/05/2013

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