Healthcare Provider Details

I. General information

NPI: 1245256163
Provider Name (Legal Business Name): SALIL G JACOB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 22ND ST S
SAINT PETERSBURG FL
33712-2744
US

IV. Provider business mailing address

1907 TYRONE BLVD N
ST PETERSBURG FL
33710-4841
US

V. Phone/Fax

Practice location:
  • Phone: 727-824-8181
  • Fax:
Mailing address:
  • Phone: 727-317-2117
  • Fax: 727-317-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME84815
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: