Provider Demographics
NPI:1023194115
Name:JACOBSON, SANFORD (MD)
Entity Type:Individual
Prefix:
First Name:SANFORD
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 SW 57TH AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5522
Mailing Address - Country:US
Mailing Address - Phone:305-663-9275
Mailing Address - Fax:305-663-9275
Practice Address - Street 1:7900 SW 57TH AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5522
Practice Address - Country:US
Practice Address - Phone:305-663-9275
Practice Address - Fax:305-663-9275
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL97962084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD59355Medicare UPIN
FL90763Medicare ID - Type Unspecified