MEDICARE: DR. RONALD IRVING JACOBY 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	207R00000X	Internal Medicine Physician	G20885	CA
2	208100000X	Physical Medicine & Rehabilitation Physician	ME90603	FL
3	208D00000X	General Practice Physician	G20885	CA
4	207R00000X	Internal Medicine Physician	ME90603	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	:	1346269669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD IRVING JACOBY M.D.

Provider Business Mailing Address
First Line	:	706 COTE AZUR DRIVE
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410
Country	:	US
Telephone Number	:	561-223-3313
Fax Number	:	561-223-3312

Provider Business Practice Location Address
First Line	:	1413 VISCAYA PKWY
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-6206
Country	:	US
Telephone Number	:	239-458-5747
Fax Number	:	239-984-5365

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	11/29/2022

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