Provider Demographics
NPI:1558369702
Name:JACOBSON, STEVEN D (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:JACOBSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9136 WILLOW BROOK DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-3258
Mailing Address - Country:US
Mailing Address - Phone:314-397-9831
Mailing Address - Fax:
Practice Address - Street 1:9136 WILLOW BROOK DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-3258
Practice Address - Country:US
Practice Address - Phone:314-397-9831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD27201207R00000X
ME27201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110230748OtherRAILROAD MEDICARE
MO10292OtherBLUE CROSS/BLUE SHIELD
MO100236OtherGROUP HEALTH PLAN
MO171748OtherHEALTHLINK
MO110230748OtherCHAMPUS
MO100236OtherGROUP HEALTH PLAN
MO110230748OtherRAILROAD MEDICARE