Individual
GARY H JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
11990 N CENTRAL EXPY, DALLAS, TX 75243-3714
(972) 234-1900
Mailing address
PO BOX 840853 SUITE 400, DALLAS, TX 75284-3755
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
530245
TX
367500000X
Certified Registered Nurse Anesthetist
N-29165
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805858000
—
ID
Enumeration date
07/18/2006
Last updated
07/02/2020
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