Provider Demographics
NPI:1851336028
Name:JACOB, MARTY (MD)
Entity type:Individual
Prefix:
First Name:MARTY
Middle Name:
Last Name:JACOB
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 1:7593 W BOYNTON BEACH BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6162
Mailing Address - Country:US
Mailing Address - Phone:561-649-7000
Mailing Address - Fax:
Practice Address - Street 1:10151 ENTERPRISE CTR STE 105
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3760
Practice Address - Country:US
Practice Address - Phone:561-484-5559
Practice Address - Fax:561-823-0429
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H52504Medicare UPIN
FL58767Medicare PIN