Healthcare Provider Details

I. General information

NPI: 1740222546
Provider Name (Legal Business Name): JACOB E ROFFE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17480 DALLAS PKWY SUITE 125
DALLAS TX
75287-7337
US

IV. Provider business mailing address

17480 DALLAS PKWY SUITE 125
DALLAS TX
75287-7337
US

V. Phone/Fax

Practice location:
  • Phone: 972-488-8926
  • Fax: 972-881-4390
Mailing address:
  • Phone: 972-488-8926
  • Fax: 972-881-4390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberH6935
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberH6935
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: