=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033114822
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES MICHAEL JACOBS DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2005
-----------------------------------------------------
Last Update Date | 01/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23230 RED RIVER DR
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77494-2046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-395-3338
-----------------------------------------------------
Fax | 281-395-3496
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23230 RED RIVER DR
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77494-2046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-221-0662
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | 1064
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------