Basic Information
| Provider Information | |||||||||
| NPI: | 1336341650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACOBS | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5310 HARVEST HILL RD STE 290 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752305826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2144200650 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14155 N 83RD AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853815640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238888145 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 10/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 5024 | AZ | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.