MEDICARE: DR. JACOB ARTHUR SAMBURSKY 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	2084N0400X	Neurology Physician	U4918	TX
2	2084N0400X	Neurology Physician	2023050076	MO
3	2084N0400X	Neurology Physician	339110	NY
4	2084N0400X	Neurology Physician	129103	MT
5	2084N0400X	Neurology Physician	MD220486	OR
6	2084N0400X	Neurology Physician	ME163526	FL
7	2084N0400X	Neurology Physician	78646	AZ
8	208M00000X	Hospitalist Physician	ME163526	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	:	1619436474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB ARTHUR SAMBURSKY MD

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-208-2212
Fax Number	:	239-935-5067

Provider Business Practice Location Address
First Line	:	11215 METRO PKWY STE 1
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-1206
Country	:	US
Telephone Number	:	239-208-2212
Fax Number	:

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

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	05/18/2026

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