MEDICARE: DR. JACOB S LANDES D.O.

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	207X00000X	Orthopaedic Surgery Physician	OS 14144	FL
2	207XS0106X	Orthopaedic Hand Surgery Physician	OS14144	FL
3	207XS0106X	Orthopaedic Hand Surgery Physician	OS 14144	FL

General Provider Information

NPI Number	:	1124394341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB S LANDES D.O.

Provider Business Mailing Address
First Line	:	9970 CENTRAL PARK BLVD N STE 300
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-2237
Country	:	US
Telephone Number	:	561-488-2200
Fax Number	:	561-488-1064

Provider Business Practice Location Address
First Line	:	9970 CENTRAL PARK BLVD N STE 300
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-2237
Country	:	US
Telephone Number	:	561-488-2200
Fax Number	:	561-488-1064

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

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	05/15/2024

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