Healthcare Provider Details

I. General information

NPI: 1992066062
Provider Name (Legal Business Name): BENJAMIN NORMAN JACOBS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 SW ARCHER RD
GAINESVILLE FL
32608-1134
US

IV. Provider business mailing address

1600 SW ARCHER RD BOX 100128
GAINESVILLE FL
32610-0128
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5484
  • Fax:
Mailing address:
  • Phone: 352-273-5484
  • Fax: 352-273-5515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME151882
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME151882
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: