Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | E2633 | TX |
NPI | 1013984319 |
---|---|
Provider Name | Dr. Edward E Jacobson |
First Address | Dallas, TX 75284-7176 |
Second Address | Longview, TX 75601-5537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2006 |
Last Update Date | 06/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
129543807 | (05) | TX |
C17381 | (02) | TX |