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NPI Code Detail

MEDICARE: DR. DAN G. JACOBSON M.D.

MEDICARE: DR. DAN G. 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
1207RG0100XGastroenterology PhysicianME0036695FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ME0036695OTHERFLWORKMANS COMP
201280OTHERFLBCBS FL AND NETWORK BLUE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194728170
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAN G. JACOBSON M.D.
Provider Business Mailing Address
First Line : 2960 NE HEATHER CT
Second Line :
City : JENSEN BEACH
State : FL
Zip : 34957-5066
Country : US
Telephone Number : 772-285-9665
Fax Number : 772-334-7232
Provider Business Practice Location Address
First Line : 2960 NE HEATHER CT
Second Line :
City : JENSEN BEACH
State : FL
Zip : 34957-5066
Country : US
Telephone Number : 772-285-9665
Fax Number : 772-334-7232
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 02/19/2021

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