Provider Demographics
NPI:1861058679
Name:JACOB, MERLIN ANN (MD)
Entity type:Individual
Prefix:
First Name:MERLIN
Middle Name:ANN
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 1:201 E I30 STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5402
Mailing Address - Country:US
Mailing Address - Phone:727-723-1009
Mailing Address - Fax:469-757-4890
Practice Address - Street 1:201 E I30 STE 100
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5402
Practice Address - Country:US
Practice Address - Phone:972-772-3100
Practice Address - Fax:469-757-4890
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT7603208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics