Individual
MATTHEW ROY JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1500 CITYWEST BLVD STE 300, HOUSTON, TX 77042-2549
(713) 620-4000
Mailing address
PO BOX 840853, DALLAS, TX 75284-8423
(713) 620-4000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
688836
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP114088
TX
Other
Enumeration date
11/17/2005
Last updated
04/28/2020
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