Provider Demographics
NPI:1982650313
Name:JAKOBSON, PEETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PEETER
Middle Name:
Last Name:JAKOBSON
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 1:2015 ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3003
Mailing Address - Country:US
Mailing Address - Phone:334-671-1696
Mailing Address - Fax:334-794-0721
Practice Address - Street 1:3301 OVERSEAS HWY
Practice Address - Street 2:FISHERMEN'S HOSPITAL RADIOLOGY
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2329
Practice Address - Country:US
Practice Address - Phone:334-671-1696
Practice Address - Fax:334-794-0721
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00394662085R0202X
FLME394662085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265816000Medicaid
D82699Medicare UPIN
FL265816000Medicaid