DR. MARK DAVID JACOBSON (NPI# 1306894423) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306894423 |
| Entity Type | Individual |
| Full Name | DR. MARK DAVID JACOBSON |
| Credential | M.D. |
| Practice Address |
769 Highway 466 Lady Lake FL 32159-6340 |
| Mailing Address |
922 Shore Acres Dr Leesburg FL 34748-9269 |
| Practice Telephone | 3522615502 |
| Practice Fax Number | 3523505942 |
| Mailing Telephone | 3522615502 |
| Mailing Fax Number | 3522615504 |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2019-11-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
ME67158 | FL | Allopathic & Osteopathic Physicians |
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
ME67158 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 376466400 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841643178 | Mark Jacobson | Counselor | 3170 N Federal Hwy Ste 206e, Lighthouse Point, FL 33064-6720 | 2016-07-21 |
| 1326375437 | Mark S Jacobson | Dentist | 800 Rose St Rm D632, Lexington, KY 40536-0297 | 2009-11-10 |
| 1801935531 | Mark J Jacobson | Social Worker | 1677 Eureka Rd Ste 203, Roseville, CA 95661-3039 | 2007-02-06 |
| 1770509002 | Mark Edwin Jacobson | Ophthalmology | 1260 N Dutton Ave Ste 160, Santa Rosa, CA 95401-7139 | 2006-07-13 |
| 1124059076 | Mark C. Jacobson | Allergy & Immunology | 911 N Elm St Ste 300, Hinsdale, IL 60521-3642 | 2006-07-06 |
| 1831178318 | Mark I Jacobson | Pathology | 560 White Plains Rd Fl 6, Tarrytown, NY 10591-5113 | 2006-01-12 |
| 1528480944 | Mark Jacobson | Psychologist | 234 1/2 Washington Ave, Grand Haven, MI 49417-3307 | 2014-01-21 |
| 1053561449 | Mark Edward Jacobson | Orthopaedic Surgery | 370 N 120th Ave, Holland, MI 49424-2196 | 2008-09-23 |
| 1760551915 | Mark David Jacobson | Orthopaedic Surgery | 5555 Reservoir Dr Ste 104, San Diego, CA 92120-5198 | 2006-11-06 |
| 1992898100 | Mark E Jacobson | Optometrist | 3409 Jerome Ave, Bronx, NY 10467-1049 | 2006-10-02 |
| Street Address |
769 HIGHWAY 466 |
| City | LADY LAKE |
| State | FL |
| Zip Code | 32159-6340 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528308350 | Medical Imaging & Therapeutics LLC | Radiology | 769 Highway 466, Suite 769, Lady Lake, FL 32159-6340 | 2013-02-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306451216 | Lindsey Porubcan | Physician Assistant | 990 South Us Highway 441/27, Lady Lake, FL 32159 | 2020-09-09 |
| 1073134979 | Michael Robert Frates | Dietitian, Registered | 900 Cr 466, Lady Lake, FL 32159 | 2020-05-01 |
| 1346800364 | Barbara Conrad | Social Worker | 906 Orchid Street, Lady Lake, FL 32159 | 2019-06-20 |
| 1962977165 | Curelogics Wound Care and Hyperbaric LLC | Registered Nurse | 809 County Road 466, Unit C-201, Lady Lake, FL 32159 | 2018-10-04 |
| 1346736907 | Caroline Butler | Physician Assistant | 805 E. Cr 466, Lady Lake, FL 32159 | 2018-07-06 |
| 1033609607 | Cyrus Immanuel Macalisang Doroy | Physical Therapist | 6340 County Rd 466, Suite 733, Lady Lake, FL 32159 | 2018-05-18 |
| 1962999680 | Sharma Institute of Pain Medicine | Physical Medicine & Rehabilitation | 1501 Us Hwy 441, Villages, FL 32159 | 2018-04-18 |
| 1538683198 | Cathleen Laurel Civiello | Psychologist | 929 H. Hwy 441, Suite 404, Lady Lake, FL 32159 | 2017-07-26 |
| 1649709015 | Adria Young | Optometrist | 801 Cr 466, Suite 102 Sunset Plaza, Lady Lake, FL 32159 | 2017-06-08 |
| 1891222527 | Center for Hope and Healing, LLC | Social Worker | 804 Hwy 466, Lady Lake, FL 32159 | 2017-05-12 |
| Find all providers in zip 32159 | ||||
| Taxonomy Code | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871100917 | Emergency and Interventional Specialists, Inc | Radiology | 5626 Gulf Dr Ste 100, New Port Richey, FL 34652-4020 | 2020-09-23 |
| 1548879794 | Vascular Specialist of Venice and Sarasota Pl | Radiology | 6600 University Parkway, #102, Sarasota, FL 34240 | 2020-07-23 |
| 1164060497 | Advanced Vascular Cardiac & Veins, Pllc | Radiology | 7480 Bird Rd Ste 560, Miami, FL 33155-6657 | 2019-12-17 |
| 1801437041 | Premier Interventional & Diagnostic Radiology, Corp | Radiology | 8495 Sw 56th St, Miami, FL 33155-5426 | 2019-09-30 |
| 1003476169 | Hss-florida Physicians LLC | Radiology | 1395 S State Road 7 Ste 410, Wellington, FL 33414-9327 | 2019-06-19 |
| 1003302712 | Ocuflow Doppler LLC | Radiology | 1855 Veterans Park Drive, Naples, FL 34109 | 2018-07-05 |
| 1972006351 | Minimally Invasive Vascular, Inc | Radiology | 2720 Us Highway 1 S Ste C, St Augustine, FL 32086-6301 | 2018-03-13 |
| 1124530761 | Radiology & Imaging Specialists of Lakeland, Pa | Radiology | 313 W Bass St, Kissimmee, FL 34741-5011 | 2017-11-03 |
| 1942727516 | Inspired Interventional Radiology Services LLC | Radiology | 11011 Sheridan St Ste 102, Hollywood, FL 33026-1501 | 2017-08-24 |
| 1386004901 | Precision Medical Imaging and Therapeutic Institute LLC | Radiology | 2540 Green Forest Ln, Suite #101, Lutz, FL 33558-5388 | 2016-02-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.