Provider Demographics
NPI:1821082017
Name:JACOBSON, GEORGE FRANKLIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:FRANKLIN
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6750
Mailing Address - Country:US
Mailing Address - Phone:954-987-0550
Mailing Address - Fax:954-987-0553
Practice Address - Street 1:3816 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6750
Practice Address - Country:US
Practice Address - Phone:954-987-0550
Practice Address - Fax:954-987-0553
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1504213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6261900001Medicare NSC