MEDICARE: SPINE EXPOSURE ASSOCIATES, PLLC

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	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1427682426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPINE EXPOSURE ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	1900 MCKINNEY AVE APT 905
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-1717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2633 DALLAS PKWY STE 100
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4715
Country	:	US
Telephone Number	:	469-562-1992
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALEXIS JACOB
Credential	:
Telephone Number	:	281-686-9406

Provider Enumeration Date	:	02/28/2020
Last Update Date	:	02/28/2020

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