Dr. Jacob S. Form, DPM
Dr. Jacob S. Form, DPM is a Podiatry in Lafayette Hill, Pennsylvania. Graduated from Temple University School of Podiatric Medicine in 1980, 46 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Pennsylvania.
- Years since qualifying
- 46
- Trained at
- Temple University School of Podiatric Medicine
- Licensed in
- PA
- In the registry since
- 2006
What do these letters mean?
- DPM — Doctor of Podiatric Medicine
- A foot and ankle physician and surgeon.
Practice location Address checks out
4129 Franklin WayLafayette Hill, PA 19444-1300
Phone: (215) 292-2637
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Podiatrist (primary) | Taxonomy 213E00000X · Licence SC002170L (PA) |
|---|
Record details
| NPI number | 1356367494 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | DPM |
| Sole proprietor | Yes |
| NPI enumerated | July 14, 2006 |
| Last updated in NPPES | April 27, 2012 |
| Mailing address | 4129 Franklin Way, Lafayette Hill, PA 19444-1300 |
Medicare enrollment
| Medicare specialty | PODIATRY |
|---|---|
| Medical school | TEMPLE UNIVERSITY SCHOOL OF PODIATRIC MEDICINE |
| Graduated | 1980 (46 years in practice) |
| Accepts Medicare assignment | Yes — accepts the Medicare-approved amount |