Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME0040342 | FL |
NPI | 1003907114 |
---|---|
Provider Name | Miss Alan L Jacobson |
First Address | Jupiter, FL 33458-3000 |
Second Address | Jupiter, FL 33458-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C12038 | (02) | FL |