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1518961531

NPI Code Detail

MEDICARE: ROBERT G JACOBY M.D.

MEDICARE: ROBERT G JACOBY M.D.

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	2084N0400X	Neurology Physician	ME171759	FL
2	2084N0400X	Neurology Physician	MD29004	ME
3	2084N0400X	Neurology Physician	37807	MN
4	2084N0400X	Neurology Physician	MD2023-0126	NM

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518961531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT G JACOBY M.D.

Provider Business Mailing Address
First Line	:	2300 MIAMI VALLEY DR
Second Line	:	STE 550
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-1298
Country	:	US
Telephone Number	:	937-438-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	11215 METRO PKWY STE 100
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-1206
Country	:	US
Telephone Number	:	239-208-2212
Fax Number	:	239-208-3994

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	01/17/2025

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Directions to “ ROBERT G JACOBY M.D.” Practice Location

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