Provider Demographics
NPI:1912081746
Name:JACOBS, JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:JACOBS
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 1:210 JUPITER LAKES BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7188
Mailing Address - Country:US
Mailing Address - Phone:561-510-7232
Mailing Address - Fax:561-444-6407
Practice Address - Street 1:210 JUPITER LAKES BLVD # 3000S202
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7191
Practice Address - Country:US
Practice Address - Phone:561-510-7232
Practice Address - Fax:561-444-6407
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2025-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME147005207KA0200X, 207KA0200X
WAMD000367842080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8020414Medicaid
A1315764Medicare ID - Type Unspecified
WA8020414Medicaid