Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 1307961 | TX |
Y | 213ES0000X | Sports Medicine | 1307961 | TX |
NPI | 1497388318 |
---|---|
Provider Name | Mr. Zachary Scott Jacobs |
First Address | Houston, TX 77025-3122 |
Second Address | Sugar Land, TX 77479-4758 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2020 |
Last Update Date | 19/02/2020 |