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1467869982
JACOB LUSTGARTEN
FORT WORTH, TX
NPI
1467869982
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: TX PA09208)
Additional Taxonomies
363A00000X Physician Assistant
Enumeration Date
2014-07-16
Last Update Date
2021-04-13
Business Address
JACOB LUSTGARTEN PA-C
1500 COOPER ST
FORT WORTH, TX 76104-2710
Phone number: 682-885-7080
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Mailing Address
JACOB LUSTGARTEN PA-C
PO BOX 733784
DALLAS, TX 75373-3784
Phone number: 682-885-1855
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