Provider Demographics
NPI:1346203338
Name:JACOBSON, THOMAS ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALBERT
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16181 PANAMA CITY BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-5423
Mailing Address - Country:US
Mailing Address - Phone:850-249-1000
Mailing Address - Fax:
Practice Address - Street 1:16181 PANAMA CITY BEACH PKWY
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-5423
Practice Address - Country:US
Practice Address - Phone:850-249-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP23556OtherHEALTHPARTNERS
MN0107954OtherMEDICA
MN52G71JAOtherBCBS OF MN
MN122110OtherUCARE MN
MN1532784OtherAMERICA'S PPO
MN6604082OtherMEDICA UC
MN1014649OtherPREFERRED ONE
MN359219700Medicaid
MN122110OtherUCARE MN
MN6604082OtherMEDICA UC
MN1014649OtherPREFERRED ONE