Provider Demographics
NPI:1548369309
Name:JACOBS, CAROL L (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:L
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 OGLETREE DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-6783
Mailing Address - Country:US
Mailing Address - Phone:936-328-8812
Mailing Address - Fax:936-328-8815
Practice Address - Street 1:400 OGLETREE DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-6783
Practice Address - Country:US
Practice Address - Phone:936-328-8812
Practice Address - Fax:936-328-8815
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ65002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169920902Medicaid
TX8P9490OtherBCBS
TX092234604Medicaid
TX7813OtherCHOICE ONE CHIPS
TX8P9490OtherBCBS
TXG43063Medicare UPIN