MEDICARE: ARIS NICHOLAS JACOB MD

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	L2343	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00246340	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AW333	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1093714966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIS NICHOLAS JACOB MD

Provider Business Mailing Address
First Line	:	2909 TUSCAN DR
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-5251
Country	:	US
Telephone Number	:	469-544-5920
Fax Number	:

Provider Business Practice Location Address
First Line	:	2489 DIPLOMAT PKWY E
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-5422
Country	:	US
Telephone Number	:	239-652-1800
Fax Number	:

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	03/29/2017

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