Provider Demographics
NPI:1003907114
Name:JACOBSON, ALAN L (MD)
Entity Type:Individual
Prefix:MISS
First Name:ALAN
Middle Name:L
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:600 HERITAGE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3000
Mailing Address - Country:US
Mailing Address - Phone:561-624-0900
Mailing Address - Fax:561-627-3006
Practice Address - Street 1:600 HERITAGE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3000
Practice Address - Country:US
Practice Address - Phone:561-624-0900
Practice Address - Fax:561-627-3006
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0040342207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC12038Medicare UPIN
FL07971ZMedicare ID - Type UnspecifiedPROVIDER NUMBER