Organization
JACOB MAYBERRY ASSISTING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB MAYBERRY CFA (OWNER)
(281) 463-6309
Entity
Organization
Contact information
Practice address
104 BLUE WATER DR, BRIDGEPORT, TX 76426-4336
(281) 463-6309
(281) 463-6835
Mailing address
PO BOX 2201, DECATUR, TX 76234-6158
(281) 463-6309
(281) 463-6835
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
C080326A
TX
Other
Enumeration date
11/02/2009
Last updated
08/19/2014
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