Individual
LESLIE JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4200 SUN N LAKE BLVD, SEBRING, FL 33872-1986
(863) 402-3103
(863) 402-5339
Mailing address
3610 YACHT CLUB DR APT 1202, SUITE # 205, AVENTURA, FL 33180-3546
(561) 756-5606
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
0101280924
VA
207RG0100X
Gastroenterology Physician
Primary
ME66002
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100011557
RAILROAD MEDICARE
FL
05
—
119868200
—
FL
01
—
28906
BLUE CROSS BLUE SHIELD OF FLA
FL
01
—
RM822
HFMG MA
FL
Enumeration date
11/20/2006
Last updated
04/16/2024
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