Provider Demographics
NPI:1073785499
Name:SAMUEL S JACOBSON MD PA
Entity Type:Organization
Organization Name:SAMUEL S JACOBSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-939-0200
Mailing Address - Street 1:1601 CLINT MOORE RD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2768
Mailing Address - Country:US
Mailing Address - Phone:561-939-5770
Mailing Address - Fax:561-939-5775
Practice Address - Street 1:1601 CLINT MOORE RD
Practice Address - Street 2:SUITE 175
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-5713
Practice Address - Country:US
Practice Address - Phone:561-939-5770
Practice Address - Fax:561-939-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32787207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty