Healthcare Provider Details

I. General information

NPI: 1386345890
Provider Name (Legal Business Name): JACOB C JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR
SAN ANTONIO TX
78234-4504
US

IV. Provider business mailing address

3551 ROGER BROOKE DR
SAN ANTONIO TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-5000
  • Fax:
Mailing address:
  • Phone: 210-916-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102209137
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: