Provider Demographics
NPI:1558728675
Name:JACOBSON, JAMES WESTERN (PHD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WESTERN
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10401 TOWN PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-5219
Mailing Address - Country:US
Mailing Address - Phone:713-621-3101
Mailing Address - Fax:281-568-5242
Practice Address - Street 1:10401 TOWN PARK DRIVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5219
Practice Address - Country:US
Practice Address - Phone:713-621-3101
Practice Address - Fax:281-568-5242
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246QM0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMicrobiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D0710715OtherCLIA