Provider Demographics
NPI:1427078658
Name:JACOBS, PATRICIA WEISS (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:WEISS
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2305
Mailing Address - Country:US
Mailing Address - Phone:561-955-2273
Mailing Address - Fax:561-955-2486
Practice Address - Street 1:701 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2305
Practice Address - Country:US
Practice Address - Phone:561-955-2273
Practice Address - Fax:561-955-2486
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68386207R00000X
FLME118354207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G683860Medicaid
CAE92224Medicare UPIN
CAWG68386BMedicare PIN