Individual
DR. GARY R JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
703 E MARSHALL AVE, #4008, LONGVIEW, TX 75601-5500
(903) 753-2276
(903) 753-7420
Mailing address
703 E MARSHALL AVE, #4008, LONGVIEW, TX 75601-5500
(903) 753-2276
(903) 753-7420
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
E4427
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110309502
—
TX
Enumeration date
07/01/2005
Last updated
07/18/2016
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