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General NPI Number Information
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NPI Number | 1821131780
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Entity Type | Individual
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Provider Name | PAUL ALLEN JACOBSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 4044 W LAKE MARY BLVD #410
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City | LAKE MARY
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State | FL
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Zip | 32746-2012
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Country | US
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Telephone | 407-718-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 4044 W LAKE MARY BLVD #410
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City | LAKE MARY
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State | FL
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Zip | 32746-2012
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Country | US
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Telephone | 407-718-8000
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 38737
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | ME38737
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License Number State | FL
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