Individual
DR. RUSSEL L. JACOBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12222 MERIT DR STE 600, DALLAS, TX 75251-3294
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0865
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
K5568
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050086412
RAILROAD
TX
05
—
150762601
—
TX
05
—
150762602
—
TX
05
—
150762603
—
TX
01
—
8740B1
BCBS
TX
01
—
8EH332
BCBS TX
TX
Enumeration date
12/23/2005
Last updated
06/03/2022
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