Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 42141-20 | WI |
N | 207QA0505X | Family Doctor - Adult Medicine | G69425 | CA |
Y | 207RG0300X | Geriatric Medicine | 120760 | FL |
NPI | 1164419578 |
---|---|
Provider Name | Dr. Michael Matthew Jacobs |
First Address | Pensacola, FL 32507-1000 |
Second Address | Pensacola, FL 32508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 18/05/2016 |