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Organization
EAST TEXAS PLASTIC SURGERY LLP
Active
Organization
EAST TEXAS PLASTIC SURGERY LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY R JACOBS MD (PRESIDENT AND CO OWNER)
(903) 753-2276
Entity
Organization
Contact information
Practice address
703 E MARSHALL AVE STE 4008, LONGVIEW, TX 75601-5622
(903) 753-2276
(903) 753-7420
Mailing address
703 E MARSHALL AVE STE 4008, LONGVIEW, TX 75601-5622
(903) 753-2276
(903) 753-7420
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
E4427
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110309502
—
TX
Enumeration date
04/16/2007
Last updated
07/18/2016
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