Provider Demographics
NPI:1174747661
Name:JACOB, CINDY S (MD)
Entity type:Individual
Prefix:DR
First Name:CINDY
Middle Name:S
Last Name:JACOB
Suffix:
Gender:F
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 1:1259 FM 1463 RD STE 400
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5480
Mailing Address - Country:US
Mailing Address - Phone:832-695-9400
Mailing Address - Fax:888-720-2860
Practice Address - Street 1:1259 FM 1463 RD STE 400
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5480
Practice Address - Country:US
Practice Address - Phone:832-695-9400
Practice Address - Fax:888-720-2860
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204948801Medicaid
TX8L17482OtherMEDICARE ID