Healthcare Provider Details

I. General information

NPI: 1144409228
Provider Name (Legal Business Name): PEETER JAKOBSON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 OVERSEAS HWY FISHERMEN'S HOSPITAL
MARATHON FL
33050
US

IV. Provider business mailing address

3301 OVERSEAS HWY FISHERMEN'S HOSPITAL
MARATHON FL
33050
US

V. Phone/Fax

Practice location:
  • Phone: 334-671-1696
  • Fax: 334-794-0721
Mailing address:
  • Phone: 334-671-1696
  • Fax: 334-794-0721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberUNKNOWN
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberUNKNOWN
License Number StateFL

VIII. Authorized Official

Name: DR. PEETER JAKOBSON
Title or Position: PRESIDENT
Credential: MD
Phone: 334-671-1696