Provider Demographics
NPI:1134106420
Name:JACOBY, RICHARD PAUL (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PAUL
Last Name:JACOBY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 N SCOTTSDALE RD STE C4005
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7666
Mailing Address - Country:US
Mailing Address - Phone:480-994-5977
Mailing Address - Fax:480-672-2288
Practice Address - Street 1:9475 E IRONWOOD SQUARE DR STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4576
Practice Address - Country:US
Practice Address - Phone:480-994-5977
Practice Address - Fax:480-672-2288
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ00084213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ189007100OtherDEPT OF LABOR
AZ0744380001OtherDMERC PIN
AZAZ0190960OtherBCBSAZ PIN
AZ480127724OtherRR MEDICARE PIN
AZ1Z1219OtherHEALTHNET PIN
AZ2572688OtherAETNA PIN
AZ700626Medicaid
AZ480127724OtherRR MEDICARE PIN
AZ700626Medicaid