MEDICARE: MARK A JACOBS 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	207V00000X	Obstetrics & Gynecology Physician	E8588	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	160040448	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	83052G	OTHER	TX	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1073515201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A JACOBS M.D.

Provider Business Mailing Address
First Line	:	7900 FANNIN ST
Second Line	:	4000
City	:	HOUSTON
State	:	TX
Zip	:	77054-2934
Country	:	US
Telephone Number	:	713-512-7000
Fax Number	:	713-512-7082

Provider Business Practice Location Address
First Line	:	7580 FANNIN ST STE 210
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1939
Country	:	US
Telephone Number	:	137-799-2515
Fax Number	:

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	10/30/2019

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Directions to “ MARK A JACOBS M.D.” Practice Location

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