MEDICARE: STEPHEN F. JACOBS 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	207RP1001X	Pulmonary Disease Physician	ME0036236	FL

General Provider Information

NPI Number	:	1912999632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN F. JACOBS M.D.

Provider Business Mailing Address
First Line	:	2500 N ATLANTIC BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33305-1912
Country	:	US
Telephone Number	:	954-701-2580
Fax Number	:	954-565-7234

Provider Business Practice Location Address
First Line	:	2500 N ATLANTIC BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33305-1912
Country	:	US
Telephone Number	:	954-701-2580
Fax Number	:	954-565-7234

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	02/11/2008

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