| Dr Lourdes R Jacobo, MD | |
|
2120 Centerpointe West Dr, Prescott, AZ 86301-8487 | |
| (928) 778-4581 | |
| (928) 776-1872 |
| Full Name | Dr Lourdes R Jacobo |
|---|---|
| Gender | Female |
| Speciality | Pediatrics |
| Location | 2120 Centerpointe West Dr, Prescott, Arizona |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861548679 | NPI | - | NPPES |
| 401708 | Medicaid | AZ | |
| 40096 | Other | AZ | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 23974 (New Jersey) | Secondary |
| 208000000X | Pediatrics | 40096 (Arizona) | Primary |
| Entity Name | Yavapai Regional Medical Center Physician Care Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1255582003 PECOS PAC ID: 5294898987 Enrollment ID: O20090106000798 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Lourdes R Jacobo, MD 16950 N 49th Way, Scottsdale, AZ 85254-1082 Ph: (623) 238-4284 | Dr Lourdes R Jacobo, MD 2120 Centerpointe West Dr, Prescott, AZ 86301-8487 Ph: (928) 778-4581 |
Dr. David Andrew Green, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1090 Commerce Dr, Prescott, AZ 86305 Phone: 928-583-1000 | |
Ronael Eckman, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2120 Centerpointe West Dr, Prescott, AZ 86301 Phone: 928-778-4581 Fax: 928-776-1872 | |
Dr. Kathryn T Ballard, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1090 Commerce Dr, Prescott, AZ 86305 Phone: 928-583-1000 Fax: 866-323-8458 | |
James M Mick, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2120 Centerpointe West Drive, Prescott, AZ 86301 Phone: 928-443-1111 Fax: 928-443-5554 | |
Jennifer Evans Tidroski, D.O. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 2120 Centerpointe West Dr, Prescott, AZ 86301 Phone: 928-778-4581 Fax: 928-776-1872 | |
Shelly Faye Klein, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1672 Oaklawn Dr., Prescott, AZ 86305 Phone: 928-445-5339 Fax: 928-445-3644 |