Provider Demographics
NPI:1346269669
Name:JACOBY, RONALD IRVING (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:IRVING
Last Name:JACOBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:706 COTE AZUR DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-223-3313
Mailing Address - Fax:561-223-3312
Practice Address - Street 1:1413 VISCAYA PKWY
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-6206
Practice Address - Country:US
Practice Address - Phone:239-458-5747
Practice Address - Fax:239-984-5365
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20885207R00000X, 208D00000X
FLME90603208100000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVADOOMedicare UPIN