Provider Demographics
NPI:1245545805
Name:JACOBSON, ROBERT ELLIOTT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ELLIOTT
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7600 SW 57TH AVE
Mailing Address - Street 2:309
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5428
Mailing Address - Country:US
Mailing Address - Phone:305-661-8288
Mailing Address - Fax:305-661-1874
Practice Address - Street 1:7600 SW 57TH AVE
Practice Address - Street 2:309
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5428
Practice Address - Country:US
Practice Address - Phone:305-661-8288
Practice Address - Fax:305-661-1874
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-08
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL24694207T00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine