Provider Demographics
NPI:1184653651
Name:THOMAS, JACOB MANNOOR (MD,)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:MANNOOR
Last Name:THOMAS
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 1:818 W FRANK AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3317
Mailing Address - Country:US
Mailing Address - Phone:936-639-6210
Mailing Address - Fax:936-639-2298
Practice Address - Street 1:818 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3317
Practice Address - Country:US
Practice Address - Phone:936-639-6210
Practice Address - Fax:936-639-2298
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85450JMedicare PIN