MEDICARE: DR. MICHAEL DAVID JACOBY 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	207P00000X	Emergency Medicine Physician	MT232236	PA

General Provider Information

NPI Number	:	1972344067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DAVID JACOBY MD

Provider Business Mailing Address
First Line	:	3900 SIERRA CIR
Second Line	:
City	:	CENTER VALLEY
State	:	PA
Zip	:	18034-8471
Country	:	US
Telephone Number	:	850-797-9555
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 SIERRA CIR
Second Line	:
City	:	CENTER VALLEY
State	:	PA
Zip	:	18034-8471
Country	:	US
Telephone Number	:	850-797-9555
Fax Number	:

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

Provider Enumeration Date	:	06/04/2024
Last Update Date	:	06/04/2024

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