Individual
MARK ALAN JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4330 MEDICAL DR STE 500, SAN ANTONIO, TX 78229-3318
(210) 558-0122
(210) 558-0120
Mailing address
4330 MEDICAL DR STE 500, SAN ANTONIO, TX 78229-3318
(210) 558-0122
(210) 558-0120
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
F4114
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135747703
—
TX
01
—
TXB150108
WELLMED NETWORKS INC
—
Enumeration date
04/11/2007
Last updated
07/16/2015
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