Provider Demographics
NPI:1346263977
Name:JACOBSON, H. NEIL (MD)
Entity Type:Individual
Prefix:
First Name:H. NEIL
Middle Name:
Last Name:JACOBSON
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 1:17440 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG72442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
264088609OtherTAX ID
752303564OtherTAX ID
TX127960605Medicaid
TX00626MMedicare ID - Type Unspecified
C17379Medicare UPIN