MEDICARE: JACOB TENNYSON WOODS D.O.

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	207Q00000X	Family Medicine Physician	R1921	AZ

General Provider Information

NPI Number	:	1235424680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB TENNYSON WOODS D.O.

Provider Business Mailing Address
First Line	:	10120 E OLD VAIL RD STE 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-9414
Country	:	US
Telephone Number	:	520-989-8012
Fax Number	:	520-959-8014

Provider Business Practice Location Address
First Line	:	10120 E OLD VAIL RD STE 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-9414
Country	:	US
Telephone Number	:	520-989-8012
Fax Number	:	520-959-8014

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

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	09/13/2021

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