Healthcare Provider Details

I. General information

NPI: 1598201790
Provider Name (Legal Business Name): DANIEL M JACOBS, M.D, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S RIVERSIDE DR
POMPANO BEACH FL
33062-5526
US

IV. Provider business mailing address

2331 N STATE ROAD 7
LAUDERDALE LAKES FL
33313-3748
US

V. Phone/Fax

Practice location:
  • Phone: 954-895-2862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME83309
License Number StateNY

VIII. Authorized Official

Name: DANIEL JACOBS
Title or Position: OWNER
Credential:
Phone: 954-895-2862