Provider Demographics
NPI:1730353830
Name:JACOB, SANDY (MD)
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:
Last Name:JACOB
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 1:3150 GULF FWY S
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-4316
Mailing Address - Country:US
Mailing Address - Phone:832-720-6345
Mailing Address - Fax:
Practice Address - Street 1:3150 GULF FWY S
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-4316
Practice Address - Country:US
Practice Address - Phone:832-720-6345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301097539207Q00000X
IN01065086A207Q00000X
NY249505207Q00000X
TXN3752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine