MEDICARE: PHILIP 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	207L00000X	Anesthesiology Physician	ME 70215	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164457859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP JACOBSON MD

Provider Business Mailing Address
First Line	:	461 RANCH RD
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-1755
Country	:	US
Telephone Number	:	954-530-4005
Fax Number	:

Provider Business Practice Location Address
First Line	:	4161 NW 5TH ST
Second Line	:	SUITE 100
City	:	PLANTATION
State	:	FL
Zip	:	33317-2101
Country	:	US
Telephone Number	:	954-585-3800
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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Directions to “ PHILIP JACOBSON MD” Practice Location

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