Provider Demographics
NPI:1184788036
Name:JACOBS, BARUCH (MD)
Entity type:Individual
Prefix:DR
First Name:BARUCH
Middle Name:
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 1:400 W 41ST ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3516
Mailing Address - Country:US
Mailing Address - Phone:305-674-8586
Mailing Address - Fax:305-674-6686
Practice Address - Street 1:400 W 41ST ST
Practice Address - Street 2:SUITE 305
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3516
Practice Address - Country:US
Practice Address - Phone:305-674-8586
Practice Address - Fax:305-674-6686
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME555152086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE65871Medicare UPIN
FL09778ZMedicare ID - Type Unspecified