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General NPI Number Information
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NPI Number | 1174714414
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Entity Type | Organization
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Legal Business Name | JACOB MEDICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 06/11/2013
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Provider Practice Location Address
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Address Line | 426 DISSTON AVE
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City | CLERMONT
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State | FL
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Zip | 34711-2633
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Country | US
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Telephone | 407-215-4999
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Fax | 888-762-3102
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Provider Business Mailing Address
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Address Line | 426 DISSTON AVE
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City | CLERMONT
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State | FL
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Zip | 34711-2633
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Country | US
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Telephone | 407-215-4999
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Fax | 888-762-3102
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | VIOLA M JACOB
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Credential | M.D
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Telephone | 321-946-6864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | ME90116
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License Number State | FL
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