Provider Demographics
NPI:1235875642
Name:HAGUE, JACOB CARL (DO)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:CARL
Last Name:HAGUE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7934 N SHORE CT
Mailing Address - Street 2:
Mailing Address - City:GRAWN
Mailing Address - State:MI
Mailing Address - Zip Code:49637-9581
Mailing Address - Country:US
Mailing Address - Phone:248-534-2819
Mailing Address - Fax:
Practice Address - Street 1:111 DALLAS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1201
Practice Address - Country:US
Practice Address - Phone:210-297-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV9616207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty