Provider Demographics
NPI:1881689073
Name:JACOBSON, SHEILA WERCH (MD)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:WERCH
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9235 KATY FWY
Mailing Address - Street 2:STE 330
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1533
Mailing Address - Country:US
Mailing Address - Phone:713-464-0822
Mailing Address - Fax:713-932-1621
Practice Address - Street 1:9225 KATY FWY STE 415
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1531
Practice Address - Country:US
Practice Address - Phone:713-464-0822
Practice Address - Fax:713-932-1621
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N63LOtherBCBS
TX035060501Medicaid
TX130011071Medicare PIN
TX00N63LOtherBCBS
F83647Medicare UPIN