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General NPI Number Information
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NPI Number | 1710271333
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Entity Type | Organization
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Legal Business Name | FORT PIERCE FAMILY CARE, INC.
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 3851 VIRGINIA AVENUE
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City | FORT PIERCE
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State | FL
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Zip | 34981
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Country | US
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Telephone | 954-661-8151
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Fax |
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Provider Business Mailing Address
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Address Line | 3709 OAK RIDGE LN
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City | WESTON
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State | FL
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Zip | 33331-3706
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Country | US
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Telephone | 954-661-8151
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JERRY JACOBSON
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Credential | MD
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Telephone | 954-661-8151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME0059609
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License Number State | FL
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