Provider Demographics
NPI:1881677508
Name:JACOBS, SAMUEL LABAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LABAN
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 1:780 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-2643
Mailing Address - Country:US
Mailing Address - Phone:954-467-4700
Mailing Address - Fax:954-467-4704
Practice Address - Street 1:780 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-2643
Practice Address - Country:US
Practice Address - Phone:954-412-7252
Practice Address - Fax:954-848-2685
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06031700207V00000X
PAMD039416L207V00000X, 207VE0102X
NJ25MA060317100207VE0102X
FLME124293207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0157600300Medicaid
FL0157600300Medicaid
C59131Medicare UPIN