Provider Demographics
NPI:1043848369
Name:DARTER, JACOB THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:THOMAS
Last Name:DARTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-1030
Mailing Address - Country:US
Mailing Address - Phone:940-937-3636
Mailing Address - Fax:940-937-9615
Practice Address - Street 1:1001 US HIGHWAY 83 N
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201-2322
Practice Address - Country:US
Practice Address - Phone:940-937-3636
Practice Address - Fax:940-937-9615
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT6214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine