Provider Demographics
NPI:1265462873
Name:JACOB, RADU (MD)
Entity type:Individual
Prefix:
First Name:RADU
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 1:8130 ROYAL PALM BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5703
Mailing Address - Country:US
Mailing Address - Phone:954-345-4333
Mailing Address - Fax:954-345-4334
Practice Address - Street 1:8130 ROYAL PALM BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5703
Practice Address - Country:US
Practice Address - Phone:954-345-4333
Practice Address - Fax:954-345-4334
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89216207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276603500Medicaid
FL276603500Medicaid