# DR. ALEXIS DANIELLE JACOB

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1881924819
- **Gender:** F
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | BP10023656 | TX | — |
| 2086S0129X | Vascular Surgery Physician | 77962-20 | WI | Yes |
| 2086S0129X | Vascular Surgery Physician | N6891 | TX | — |

## Other

- **Enumeration date:** 01/14/2010
- **Last updated:** 06/12/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1881924819 | — | WI |