Provider Demographics
NPI:1982631404
Name:JACOBSEN, PAUL ERIC (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ERIC
Last Name:JACOBSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:152 NE 167TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3400
Mailing Address - Country:US
Mailing Address - Phone:305-945-5437
Mailing Address - Fax:305-945-0173
Practice Address - Street 1:152 NE 167TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3400
Practice Address - Country:US
Practice Address - Phone:305-945-5437
Practice Address - Fax:305-945-0173
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF02204Medicare UPIN
FL80298Medicare ID - Type Unspecified