Individual
MR. JOSE JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1215 S 9TH ST, LEESBURG, FL 34748-6845
(352) 512-9104
Mailing address
1215 S 9TH ST, LEESBURG, FL 34748-6845
(352) 512-9104
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
200200553
NC
207RC0000X
Cardiovascular Disease Physician
Primary
ME146896
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109046000
—
FL
05
—
89131E0
—
NC
Enumeration date
05/25/2006
Last updated
01/08/2026
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