MEDICARE: MR. JACOB BILL GARCIA COTA

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	282N00000X	General Acute Care Hospital	208524	TX

General Provider Information

NPI Number	:	1023267341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JACOB BILL GARCIA COTA

Provider Business Mailing Address
First Line	:	4055 PARK LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-1811
Country	:	US
Telephone Number	:	214-298-8999
Fax Number	:

Provider Business Practice Location Address
First Line	:	4055 PARK LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75220-1811
Country	:	US
Telephone Number	:	214-298-8999
Fax Number	:

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

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	09/10/2008

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