Jacobson, Mark David

Jacobson, Mark David is an individual health care provider with primary practice located at 769 Highway 466 , Lady Lake FL 32159-6340. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology. Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology is his primary health care specialty. Jacobson, Mark David can be contacted via phone (352) 261-5502.

Contact Information

Primary practice address
769 Highway 466 Lady Lake FL 32159-6340
Phone: (352) 261-5502
Fax: (352) 350-5942
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X ME67158 Florida
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X ME67158 Florida

Profile Details

NPI number 1306894423
LBN Legal business name Jacobson, Mark David
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2006
Last updated Nov 12th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306894423 NPPES
Florida MEDICAID 376466400

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