Individual
EMMANUEL P JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3601 SW 160TH AVE STE 250, MIRAMAR, FL 33027-6314
(877) 866-7123
Mailing address
133 MALDEN ST, MALDEN, MA 02148-6518
(781) 249-0303
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
272930
MA
208600000X
Surgery Physician
Primary
272930
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/06/2015
Last updated
03/28/2024
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