Individual
JOB JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5002 COWHORN CREEK RD, TEXARKANA, TX 75503-9766
(903) 614-3000
(903) 614-3525
Mailing address
5002 COWHORN CREEK RD, TEXARKANA, TX 75503-9766
(903) 614-3000
(903) 614-3525
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R-4415
AR
207RG0100X
Gastroenterology Physician
Primary
K6865
TX
207RG0100X
Gastroenterology Physician
R-4415
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122956001
—
AR
01
—
55893
BCBS
AR
Enumeration date
04/25/2006
Last updated
07/19/2022
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