Healthcare Provider Details

I. General information

NPI: 1518085984
Provider Name (Legal Business Name): JEFFREY A JACOBS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W TOWN AND COUNTRY RD STE 1300
ORANGE CA
92868-4654
US

IV. Provider business mailing address

1100 W TOWN AND COUNTRY RD STE 1300
ORANGE CA
92868-4654
US

V. Phone/Fax

Practice location:
  • Phone: 856-745-1151
  • Fax: 714-923-3803
Mailing address:
  • Phone: 856-745-1151
  • Fax: 714-923-3803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberG062853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: