Healthcare Provider Details

I. General information

NPI: 1629255005
Provider Name (Legal Business Name): BARUCH JACOBS MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ARTHUR GODFREY RD SUITE 305
MIAMI BEACH FL
33140-3516
US

IV. Provider business mailing address

400 ARTHUR GODFREY RD SUITE 305
MIAMI BEACH FL
33140-3516
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-8586
  • Fax: 305-674-6686
Mailing address:
  • Phone: 305-674-8586
  • Fax: 305-674-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number55515
License Number StateFL

VIII. Authorized Official

Name: DR. BARUCH JACOBS
Title or Position: DIRECTOR
Credential: M.D.
Phone: 305-674-8586