MEDICARE: H. NEIL JACOBSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	G7244	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	264088609	OTHER	TAX ID
2	752303564	OTHER	TAX ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346263977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	H. NEIL JACOBSON M.D.

Provider Business Mailing Address
First Line	:	17440 DALLAS PKWY
Second Line	:	SUITE 208
City	:	DALLAS
State	:	TX
Zip	:	75287-7336
Country	:	US
Telephone Number	:	972-248-1717
Fax Number	:	972-248-4599

Provider Business Practice Location Address
First Line	:	17440 DALLAS PKWY
Second Line	:	SUITE 208
City	:	DALLAS
State	:	TX
Zip	:	75287-7336
Country	:	US
Telephone Number	:	972-248-1717
Fax Number	:	972-248-4599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	11/14/2014

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