Provider Demographics
NPI:1285747733
Name:JACOBS, JAY PAUL II (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:PAUL
Last Name:JACOBS
Suffix:II
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 1:322 MANSFIELD H
Mailing Address - Street 2:CENTURY VILLAGE
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2424
Mailing Address - Country:US
Mailing Address - Phone:561-236-8524
Mailing Address - Fax:
Practice Address - Street 1:322 MANSFIELD H
Practice Address - Street 2:CENTURY VILLAGE
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2424
Practice Address - Country:US
Practice Address - Phone:561-236-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8978WMedicare PIN
FLG84496Medicare UPIN