Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 20167 | MN |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | Q0465 | TX |
NPI | 1184816506 |
---|---|
Provider Name | Katherine Marie Jacobs |
First Address | Fort Worth, TX 76104-2158 |
Second Address | Fort Worth, TX 76104-2158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2007 |
Last Update Date | 10/10/2014 |