Provider Demographics
NPI:1255390605
Name:JACOBI, JAY (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:JACOBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 PAN AMERICAN FWY NE
Mailing Address - Street 2:100
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3427
Mailing Address - Country:US
Mailing Address - Phone:505-823-1010
Mailing Address - Fax:505-797-4503
Practice Address - Street 1:6100 PAN AMERICAN FWY NE
Practice Address - Street 2:100
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3427
Practice Address - Country:US
Practice Address - Phone:505-823-1010
Practice Address - Fax:505-797-4503
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM93289173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD61232Medicare UPIN