Provider Demographics
NPI:1356364384
Name:JACOBSON, MIKAEL JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:MIKAEL
Middle Name:JAMES
Last Name:JACOBSON
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 1:8111 MAINLAND DR
Mailing Address - Street 2:SUITE 104448
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3748
Mailing Address - Country:US
Mailing Address - Phone:210-363-5471
Mailing Address - Fax:888-471-3818
Practice Address - Street 1:8550 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1803
Practice Address - Country:US
Practice Address - Phone:210-541-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL53862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX551369OtherVALUE OPTIONS #
TX8DJ721OtherBCBSTX
TX175829401OtherTMHP
TX202949040OtherTRICARE PROVIDER ID
TXL5386OtherTEXAS STATE LICENSE #
TX8S7470OtherBCBS PROVIDER #
TX164124306Medicaid
TXBJ8081426OtherDEA NUMBER
TX175829401OtherTMHP
TX8DJ721OtherBCBSTX
TXBJ8081426OtherDEA NUMBER