Provider Demographics
NPI:1245225762
Name:TANGIR, JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:TANGIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12741 MIRAMAR PKWY
Mailing Address - Street 2:SUITE#302
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2903
Mailing Address - Country:US
Mailing Address - Phone:954-602-9723
Mailing Address - Fax:954-602-9724
Practice Address - Street 1:12741 MIRAMAR PARKWAY
Practice Address - Street 2:SUITE#302
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3661
Practice Address - Country:US
Practice Address - Phone:954-602-9723
Practice Address - Fax:954-602-9724
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0090853207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270798500Medicaid
FL52128OtherBCBS OF FL. PROVIDER #
FLU3633ZMedicare ID - Type Unspecified
FLH36639Medicare UPIN