Provider Demographics
NPI:1639177439
Name:JACOBSON, ARTHUR RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:RAY
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A.
Other - Middle Name:RAY
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1305 WONDER WORLD DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7546
Mailing Address - Country:US
Mailing Address - Phone:512-396-7575
Mailing Address - Fax:512-396-7555
Practice Address - Street 1:1305 WONDER WORLD DR
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7546
Practice Address - Country:US
Practice Address - Phone:512-396-7575
Practice Address - Fax:512-396-7555
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5046207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1233421-05Medicaid
TX1233421-05Medicaid
E13736Medicare UPIN