Provider Demographics
NPI:1346223856
Name:JAKOB, TRACY F (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:F
Last Name:JAKOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14140 SOUTHWEST FWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3842
Mailing Address - Country:US
Mailing Address - Phone:281-649-7000
Mailing Address - Fax:713-484-6649
Practice Address - Street 1:18300 KATY FWY
Practice Address - Street 2:SUITE 305
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1385
Practice Address - Country:US
Practice Address - Phone:281-578-1910
Practice Address - Fax:281-578-1774
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4331207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118067103Medicaid
TXTXB166198OtherMEDICARE -GROUP
TX118067103Medicaid