Provider Demographics
NPI:1477527208
Name:JACOBS, JEFFREY P (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
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 1:601 FIFTH STREET SOUTH
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4804
Mailing Address - Country:US
Mailing Address - Phone:727-767-6666
Mailing Address - Fax:727-767-8606
Practice Address - Street 1:601 FIFTH STREET SOUTH
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4804
Practice Address - Country:US
Practice Address - Phone:727-767-6666
Practice Address - Fax:727-767-8606
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64472208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2255881OtherCIGNA
FL31231OtherBCBS
FL3306541OtherAETNA
FL250840100Medicaid
FL10334OtherWELLCARE
FL134223953OtherHUMANA
FL1644152OtherUNITED
FL10334OtherSTAYWELL
FL243179OtherAVMED
FL250840100Medicaid
FL31231OtherBCBS
G68216Medicare UPIN