Provider Demographics
NPI:1467729749
Name:JACOBO VARON, M.D.,P.A.
Entity Type:Organization
Organization Name:JACOBO VARON, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOBO
Authorized Official - Middle Name:
Authorized Official - Last Name:VARON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-790-9090
Mailing Address - Street 1:4817 BISSONNET ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4045
Mailing Address - Country:US
Mailing Address - Phone:713-790-9090
Mailing Address - Fax:713-790-9639
Practice Address - Street 1:4817 BISSONNET ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4045
Practice Address - Country:US
Practice Address - Phone:713-790-9090
Practice Address - Fax:713-790-9639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3946208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033055701Medicaid
TX00EV31Medicare PIN