Individual
DR. MIKAEL JAMES JACOBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8550 HUEBNER RD, SAN ANTONIO, TX 78240-1803
(210) 541-5300
Mailing address
8111 MAINLAND DR, SUITE 104448, SAN ANTONIO, TX 78240-3748
(210) 363-5471
(888) 471-3818
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
L5386
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164124306
—
TX
01
—
175829401
TMHP
TX
01
—
202949040
TRICARE PROVIDER ID
TX
01
—
551369
VALUE OPTIONS #
TX
01
—
8DJ721
BCBSTX
TX
01
—
8S7470
BCBS PROVIDER #
TX
01
—
L5386
TEXAS STATE LICENSE #
TX
Enumeration date
07/25/2006
Last updated
03/07/2023
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