MEDICARE: EJMD, PLLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1356039317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EJMD, PLLC

Provider Business Mailing Address
First Line	:	3801 PGA BLVD STE 600
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2756
Country	:	US
Telephone Number	:	561-815-9791
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 PGA BLVD STE 600
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-2756
Country	:	US
Telephone Number	:	561-815-9791
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	DR. EVAN L JACOBSON
Credential	:	MD
Telephone Number	:	561-815-9791

Provider Enumeration Date	:	04/27/2023
Last Update Date	:	12/27/2023

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