Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | N7548 | TX |
N | 208600000X | Surgeon | N7548 | TX |
Y | 2086S0105X | Surgery of the Hand | N7548 | TX |
NPI | 1114119542 |
---|---|
Provider Name | Dr. Shushan Jacob |
First Address | Arlington, TX 76012-2579 |
Second Address | Arlington, TX 76012-2579 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 22/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
286943004 | (05) | TX |
286943005 | (05) | TX |