Provider Demographics
NPI:1598887333
Name:DOERING, JACOB P (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:P
Last Name:DOERING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:19701 KINGWOOD DR STE B
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3773
Mailing Address - Country:US
Mailing Address - Phone:936-270-4680
Mailing Address - Fax:
Practice Address - Street 1:22710 PROFESSIONAL DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339
Practice Address - Country:US
Practice Address - Phone:281-359-1190
Practice Address - Fax:281-359-1540
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM4764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036119497OtherLICENSE