Provider Demographics
NPI:1740222546
Name:ROFFE, JACOB E (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:E
Last Name:ROFFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17480 DALLAS PKWY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7337
Mailing Address - Country:US
Mailing Address - Phone:972-488-8926
Mailing Address - Fax:972-881-4390
Practice Address - Street 1:17480 DALLAS PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7337
Practice Address - Country:US
Practice Address - Phone:972-488-8926
Practice Address - Fax:972-881-4390
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6935174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A0741Medicare PIN
TXTXB104615Medicare PIN