Basic Information
| Provider Information | |||||||||
| NPI: | 1003907114 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACOBSON | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 HERITAGE DR | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334583000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616240900 | ||||||||
| FaxNumber: | 5616273006 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 HERITAGE DR | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334583000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616240900 | ||||||||
| FaxNumber: | 5616273006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0905X | ME0040342 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngology/Facial Plastic Surgery |
No ID Information.