Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 12428 | TX |
N | 111NN0400X | Neurology | CHIR009098 | GA |
NPI | 1437574258 |
---|---|
Provider Name | Dr. Jacob Shores |
First Address | Grapevine, TX 76051-5187 |
Second Address | Grapevine, TX 76051-5187 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2014 |
Last Update Date | 03/03/2014 |