Provider Demographics
NPI:1114189081
Name:MANDEL, JACOB JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:JOSEPH
Last Name:MANDEL
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 1:7200 CAMBRIDGE ST
Mailing Address - Street 2:BCM609
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4202
Mailing Address - Country:US
Mailing Address - Phone:713-798-8259
Mailing Address - Fax:713-798-7709
Practice Address - Street 1:7200 CAMBRIDGE ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4202
Practice Address - Country:US
Practice Address - Phone:713-798-8259
Practice Address - Fax:713-798-7709
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339362105Medicaid
TX358842YKXUMedicare PIN