Individual
KENNETH H JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 1ST AVE, NEW YORK, NY 10016-6402
(212) 263-5072
Mailing address
PO BOX 99371, FORT WORTH, TX 76199-0371
(682) 885-1855
(682) 885-7347
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
L2345
TX
207LP3000X
Pediatric Anesthesiology Physician
Primary
L2345
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00N47F
BCBSTX GRP PIN
TX
01
—
0324290
CIGNA PIN
TX
01
—
10030778
AMERIGROUP PIN
TX
01
—
115891100
FIRSTCARE PIN
TX
01
—
1192925
FIRSTHEALTH PIN
TX
01
—
124217
SUPERIOR PIN
TX
05
—
137345809
—
TX
05
—
140442853
—
TX
01
—
1447220850
GRP NPI NUMBER
—
05
—
147834901
—
TX
05
—
147834902
—
TX
01
—
1950571
UHC PIN
TX
01
—
7067290
AETNA PIN
TX
01
—
88413Y
BCBSTX IND PIN
TX
01
—
9187586
PHCS PIN
TX
Enumeration date
10/02/2006
Last updated
08/29/2022
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