Healthcare Provider Details

I. General information

NPI: 1073618161
Provider Name (Legal Business Name): JAIME M LEDESMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 N WILMOT RD
TUCSON AZ
85712-5154
US

IV. Provider business mailing address

5055 E BROADWAY BLVD STE A100
TUCSON AZ
85711-3629
US

V. Phone/Fax

Practice location:
  • Phone: 520-722-6858
  • Fax: 520-722-8781
Mailing address:
  • Phone: 520-382-1205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number16286
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: