East Texas Plastic Surgery LLP

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

E4427 Issued in TX

Legal business name

EAST TEXAS PLASTIC SURGERY LLP

Practice address

703 E Marshall Ave Ste 4008
Longview, TX 75601-5622

Phone

(903) 753-2276

Fax

(903) 753-7420

NPI assigned

Apr 16, 2007

Last updated

Jul 18, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gary R Jacobs, MDNPI 1407853732

Title

President and Co Owner

Phone

(903) 753-2276

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gary R Jacobs, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Longview, TX
  • NPI 1407853732
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468800000000",
    "number": "1215152251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 E MARSHALL AVE STE 4008",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015622",
            "telephone_number": "903-753-2276",
            "fax_number": "903-753-7420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 E MARSHALL AVE STE 4008",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015622",
            "telephone_number": "903-753-2276",
            "fax_number": "903-753-7420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TEXAS PLASTIC SURGERY LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2016-07-18",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT AND CO OWNER",
        "authorized_official_telephone_number": "903-753-2276",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "TX",
            "license": "E4427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110309502",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East Texas Medical Specialists PLLC
• East Texas Minimally Inva Micro NS
• East Texas Oral & Maxillofacial Surgery Associates Inc.
• East Texas Performance Rehabilitation Inc
• East Texas PHC, LLC (Premier HomeCare)
• East Texas Primary Care Physicians, PLLC (Primary Care Associates)
• East Texas Prosthetic-Orthotic Care
• East Texas Psychiatry Associates
• East Texas Pulmonary Associates of Longview, PLLC (East Texas Pulmonary Associates)
• East Texas Radiology Consultants

• Plastic and Reconstructive Surgery Physician in Longview, TX
• Providers in Longview, TX by specialty
• Plastic and Reconstructive Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.