Healthcare Provider Details

I. General information

NPI: 1477527208
Provider Name (Legal Business Name): JEFFREY P JACOBS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 FIFTH STREET SOUTH 2ND FLOOR
ST PETERSBURG FL
33701-4804
US

IV. Provider business mailing address

601 FIFTH STREET SOUTH 2ND FLOOR
ST PETERSBURG FL
33701-4804
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-6666
  • Fax: 727-767-8606
Mailing address:
  • Phone: 727-767-6666
  • Fax: 727-767-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME64472
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: