Provider Demographics
NPI:1568579621
Name:JACOBSON, LEAH (MD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19238 STONEHUE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3447
Mailing Address - Country:US
Mailing Address - Phone:210-494-2223
Mailing Address - Fax:210-941-0142
Practice Address - Street 1:15316 HUEBNER RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-0988
Practice Address - Country:US
Practice Address - Phone:210-479-9292
Practice Address - Fax:210-479-9294
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7772208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105395101Medicaid
TX105395101Medicaid
TX370011513Medicare PIN
TX105395101Medicaid