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General NPI Number Information
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NPI Number | 1619950169
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Entity Type | Individual
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Provider Name | MICHAEL A JACOBS MD PA
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Gender | Male
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Dates
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Enumeration Date | 11/29/2005
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 3370 BURNS RD SUITE 101
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4327
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Country | US
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Telephone | 561-624-9797
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Fax | 561-624-0416
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Provider Business Mailing Address
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Address Line | 3370 BURNS RD SUITE 101
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4327
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Country | US
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Telephone | 561-624-9797
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Fax | 561-624-0416
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME0066801
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License Number State | FL
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