Provider Demographics
NPI:1073515201
Name:JACOBS, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:JACOBS
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 1:7900 FANNIN ST
Mailing Address - Street 2:4000
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2934
Mailing Address - Country:US
Mailing Address - Phone:713-512-7000
Mailing Address - Fax:713-512-7082
Practice Address - Street 1:7580 FANNIN ST STE 210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1939
Practice Address - Country:US
Practice Address - Phone:137-799-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8588207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160040448OtherMEDICARE RAILROAD
TX1170938-04Medicaid
TX83052GOtherBLUE CROSS & BLUE SHIELD
TX84280JMedicare ID - Type UnspecifiedHARRIS COUNTY
TX1170938-04Medicaid
TX84382JMedicare ID - Type UnspecifiedFT. BEND COUNTY
TXC17371Medicare UPIN