Provider Demographics
NPI:1437158441
Name:JACOBY, ERIC B (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:B
Last Name:JACOBY
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:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8450
Mailing Address - Fax:817-378-3699
Practice Address - Street 1:3108 MIDWAY RD STE 201
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-1613
Practice Address - Country:US
Practice Address - Phone:972-473-2020
Practice Address - Fax:972-473-2077
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2501207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096500602Medicaid
TX1386732683Medicaid
TX00307JMedicare ID - Type Unspecified
TXG46851Medicare UPIN
TX096500602Medicaid
8F5351Medicare PIN