Provider Demographics
NPI:1164512075
Name:JAKUBOWSKI, WIESLAW JOZEF (MD)
Entity Type:Individual
Prefix:
First Name:WIESLAW
Middle Name:JOZEF
Last Name:JAKUBOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WESLEY
Other - Middle Name:JOSEPH
Other - Last Name:JAKUBOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5920 SARATOGA BLVD
Mailing Address - Street 2:STE.340
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4103
Mailing Address - Country:US
Mailing Address - Phone:361-985-2111
Mailing Address - Fax:361-985-2422
Practice Address - Street 1:5920 SARATOGA BLVD
Practice Address - Street 2:STE.340
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4103
Practice Address - Country:US
Practice Address - Phone:361-985-2111
Practice Address - Fax:361-985-2422
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9715208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136442406Medicaid
TX136442401OtherCSHCN
TX89G070OtherBLUE CROSS BLUE SHIELD
TX136442406Medicaid