MEDICARE: MISS ALAN L JACOBSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	ME0040342	FL

General Provider Information

NPI Number	:	1003907114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ALAN L JACOBSON M.D.

Provider Business Mailing Address
First Line	:	600 HERITAGE DR
Second Line	:	SUITE 220
City	:	JUPITER
State	:	FL
Zip	:	33458-3000
Country	:	US
Telephone Number	:	561-624-0900
Fax Number	:	561-627-3006

Provider Business Practice Location Address
First Line	:	600 HERITAGE DR
Second Line	:	SUITE 220
City	:	JUPITER
State	:	FL
Zip	:	33458-3000
Country	:	US
Telephone Number	:	561-624-0900
Fax Number	:	561-627-3006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/09/2007

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