MEDICARE: DR. JACOB MICHAEL FEAGANS 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	207R00000X	Internal Medicine Physician	MD.201317	LA
2	207RG0100X	Gastroenterology Physician	TRN13023	FL
3	207RG0100X	Gastroenterology Physician	21382	MS
4	207RG0100X	Gastroenterology Physician	ME153671	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15513591	OTHER		CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932389681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB MICHAEL FEAGANS MD

Provider Business Mailing Address
First Line	:	4800 BELFORT RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6004
Country	:	US
Telephone Number	:	850-390-4540
Fax Number	:	850-390-4540

Provider Business Practice Location Address
First Line	:	23 MACK BAYOU LOOP
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-2606
Country	:	US
Telephone Number	:	850-390-4540
Fax Number	:	850-390-4540

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

Provider Enumeration Date	:	11/10/2007
Last Update Date	:	07/01/2022

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