Provider Demographics
NPI:1427898592
Name:JACOB, DHANYA MARY (DO)
Entity type:Individual
Prefix:
First Name:DHANYA
Middle Name:MARY
Last Name:JACOB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:172 RAVENWOOD VILLAGE DR APT 621
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-1637
Mailing Address - Country:US
Mailing Address - Phone:210-859-2389
Mailing Address - Fax:
Practice Address - Street 1:110 MEMORIAL HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4940
Practice Address - Country:US
Practice Address - Phone:936-291-4204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10090705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine