MEDICARE: GERALDINE M JACOBSON MD

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	2085R0001X	Radiation Oncology Physician	34500	IA
2	2085R0001X	Radiation Oncology Physician	24703	WV
3	2085R0001X	Radiation Oncology Physician	ME50372	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44316	OTHER	IA	WELLMARK BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164423232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALDINE M JACOBSON MD

Provider Business Mailing Address
First Line	:	PO BOX 9234
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26506-9234
Country	:	US
Telephone Number	:	304-293-7227
Fax Number	:	304-598-4717

Provider Business Practice Location Address
First Line	:	12902 USF MAGNOLIA DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-9416
Country	:	US
Telephone Number	:	813-745-7365
Fax Number	:	813-449-8618

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	01/23/2024

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Directions to “ GERALDINE M JACOBSON MD” Practice Location

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