Provider Demographics
NPI:1629262621
Name:NURKO, JACOBO (MD)
Entity Type:Individual
Prefix:
First Name:JACOBO
Middle Name:
Last Name:NURKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1401
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-5200
Mailing Address - Fax:
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1401
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-6566
Practice Address - Fax:713-790-3370
Is Sole Proprietor?:No
Enumeration Date:2007-09-02
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4793174400000X
TXN65412086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216536701Medicaid
TXP01301636OtherRR MEDICARE
AR440025801Medicaid
TXP01039331OtherRR MEDICARE
TX216536702Medicaid
TX1629262621OtherBLUE CROSS BLUE SHIELD
AR440025801Medicaid
TX216536702Medicaid