Provider Demographics
NPI:1326121674
Name:GOLDBERG, JACOBO (MD)
Entity Type:Individual
Prefix:
First Name:JACOBO
Middle Name:
Last Name:GOLDBERG
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 1:7500 BEECHNUT ST
Mailing Address - Street 2:SUITE 352
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-4335
Mailing Address - Country:US
Mailing Address - Phone:713-988-4334
Mailing Address - Fax:713-988-6165
Practice Address - Street 1:7500 BEECHNUT ST
Practice Address - Street 2:SUITE 352
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-4335
Practice Address - Country:US
Practice Address - Phone:713-988-4334
Practice Address - Fax:713-988-6165
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXB7410208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F4960OtherBCBS
TX00HF43Medicare ID - Type Unspecified