Healthcare Provider Details

I. General information

NPI: 1760010532
Provider Name (Legal Business Name): JACOB AARON LIFTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 N CRAYCROFT RD BLDG 6
TUCSON AZ
85712-2845
US

IV. Provider business mailing address

2121 N CRAYCROFT RD BLDG 6
TUCSON AZ
85712-2845
US

V. Phone/Fax

Practice location:
  • Phone: 520-886-2597
  • Fax:
Mailing address:
  • Phone: 520-886-2597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number77005
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA190687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: