Provider Demographics
NPI:1093589921
Name:JACOBSEN, MEGAN CAROL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:CAROL
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1515 HOLCOMBE BLVD UNIT 1472
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4000
Mailing Address - Country:US
Mailing Address - Phone:507-398-7921
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD UNIT 1472
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:507-398-7921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXFMP020002552085R0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics