Provider Demographics
NPI:1669459962
Name:RICHARD P JACOBY DPM, PC
Entity Type:Organization
Organization Name:RICHARD P JACOBY DPM, PC
Other - Org Name:EXTREMITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:JACOBY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-994-5977
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:480-990-9397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
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?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2572688OtherAETNA PIN
AZ700626Medicaid
AZDA8041OtherRR MEDICARE PIN
AZ189007100OtherDEPT OF LABOR
AZAZ0190960OtherBCBSAZ PIN
AZ1Z1219OtherHEALTHNET PIN
AZZ66596Medicare PIN
AZ0744380001Medicare NSC
AZ1Z1219OtherHEALTHNET PIN