MEDICARE: DR. NAOMI JANE D'ACOLATSE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	Q9143	TX
2	207Q00000X	Family Medicine Physician	Q9143	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H08GG00701	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073855698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NAOMI JANE D'ACOLATSE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 749
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-1614
Country	:	US
Telephone Number	:	956-362-8383
Fax Number	:	956-362-8382

Provider Business Practice Location Address
First Line	:	128 N FM 3167
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-6211
Country	:	US
Telephone Number	:	956-487-9025
Fax Number	:	956-487-4680

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2013
Last Update Date	:	03/11/2025

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