Provider Demographics
NPI:1245206143
Name:JACOBS, MOISES (MD,FACS)
Entity Type:Individual
Prefix:DR
First Name:MOISES
Middle Name:
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9380 SW 150TH ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7947
Mailing Address - Country:US
Mailing Address - Phone:305-256-5242
Mailing Address - Fax:305-256-5324
Practice Address - Street 1:9380 SW 150TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7947
Practice Address - Country:US
Practice Address - Phone:305-256-5242
Practice Address - Fax:305-256-5324
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42154208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD64699Medicare UPIN
FL94424Medicare ID - Type Unspecified