Provider Demographics
NPI:1114208733
Name:H. NEIL JACOBSON, MD PA
Entity Type:Organization
Organization Name:H. NEIL JACOBSON, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:H.
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-248-1717
Mailing Address - Street 1:17440 DALLAS PKWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7336
Mailing Address - Country:US
Mailing Address - Phone:972-248-1717
Mailing Address - Fax:972-248-4599
Practice Address - Street 1:17440 DALLAS PKWY
Practice Address - Street 2:SUITE 208
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7336
Practice Address - Country:US
Practice Address - Phone:972-248-1717
Practice Address - Fax:972-248-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG72442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty