MEDICARE: JAY JACOBI 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	173000000X	Legal Medicine	93289	NM

General Provider Information

NPI Number	:	1255390605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY JACOBI MD

Provider Business Mailing Address
First Line	:	6100 PAN AMERICAN FWY NE
Second Line	:	100
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3427
Country	:	US
Telephone Number	:	505-823-1010
Fax Number	:	505-797-4503

Provider Business Practice Location Address
First Line	:	6100 PAN AMERICAN FWY NE
Second Line	:	100
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-3427
Country	:	US
Telephone Number	:	505-823-1010
Fax Number	:	505-797-4503

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	07/08/2007

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Directions to “ JAY JACOBI MD” Practice Location

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