Provider Demographics
NPI:1356323166
Name:JACOBS, DANIEL HARRY (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:HARRY
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3849 OAKWATER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806
Mailing Address - Country:US
Mailing Address - Phone:407-240-1762
Mailing Address - Fax:407-812-5869
Practice Address - Street 1:3849 OAKWATER CIRCLE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:407-240-1762
Practice Address - Fax:407-812-5869
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00635212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253371500Medicaid
FL130020568OtherRAILROAD MEDICARE
FL42335OtherBLUECROSS BLUESHIELD
FL3246418-010OtherCIGNA
FL130020568OtherRAILROAD MEDICARE
FL253371500Medicaid
FL3246418-010OtherCIGNA