Provider Demographics
NPI:1568595411
Name:LABAHN, JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:LABAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 N SANTA ROSA AVE STE F4703
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3108
Mailing Address - Country:US
Mailing Address - Phone:210-704-2535
Mailing Address - Fax:210-704-2545
Practice Address - Street 1:333 N SANTA ROSA AVE
Practice Address - Street 2:CENTER FOR CHILDREN & FAMILIES, 4TH FLOOR, CLINIC A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3108
Practice Address - Country:US
Practice Address - Phone:210-704-4140
Practice Address - Fax:210-704-4142
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine