Individual
DR. MARK DAVID JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
769 HIGHWAY 466, LADY LAKE, FL 32159-6340
(352) 261-5502
(352) 350-5942
Mailing address
922 SHORE ACRES DR, LEESBURG, FL 34748-9269
(352) 261-5502
(352) 261-5504
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
ME67158
FL
2085R0204X
Vascular & Interventional Radiology Physician
Primary
ME67158
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376466400
—
FL
Enumeration date
05/04/2006
Last updated
11/12/2019
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