Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | N5220 | TX |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | N5220 | TX |
NPI | 1063628964 |
---|---|
Provider Name | Dr. Jacob Benjamin Manuel |
First Address | Austin, TX 78705-1804 |
Second Address | Austin, TX 78705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 21/03/2017 |