Individual
MICAH A JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5323 HARRY HINES BLVD, DALLAS, TX 75390-7208
(214) 456-7255
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(214) 456-7255
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
226084
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N9074
TEXAS MEDICAL BOARD
TX
Enumeration date
06/05/2006
Last updated
07/06/2011
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