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General NPI Number Information
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NPI Number | 1881677508
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Entity Type | Individual
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Provider Name | SAMUEL LABAN JACOBS MD
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Gender | Male
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 780 SW 24TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33315-2643
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Country | US
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Telephone | 954-412-7252
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Fax | 954-848-2685
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Provider Business Mailing Address
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Address Line | 780 SW 24TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33315-2643
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Country | US
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Telephone | 954-467-4700
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Fax | 954-467-4704
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MA06031700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD039416L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | MD039416L
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 25MA060317100
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME124293
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License Number State | FL
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