Provider Demographics
NPI:1194728170
Name:JACOBSON, DAN G (MD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:G
Last Name:JACOBSON
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 1:2960 NE HEATHER CT
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-5066
Mailing Address - Country:US
Mailing Address - Phone:772-285-9665
Mailing Address - Fax:772-334-7232
Practice Address - Street 1:2960 NE HEATHER CT
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-5066
Practice Address - Country:US
Practice Address - Phone:772-285-9665
Practice Address - Fax:772-334-7232
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036695207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0036695OtherWORKMANS COMP
FL01280OtherBCBS FL AND NETWORK BLUE
FL066502900Medicaid
FLME0036695OtherWORKMANS COMP