MEDICARE: MESA FAMILY PRACTICE/JACOBO A. RUYBAL 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	207Q00000X	Family Medicine Physician	24283	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255560454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESA FAMILY PRACTICE/JACOBO A. RUYBAL M.D.

Provider Business Mailing Address
First Line	:	2231 N 7TH ST
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-7434
Country	:	US
Telephone Number	:	970-243-1331
Fax Number	:	970-243-9190

Provider Business Practice Location Address
First Line	:	2231 N 7TH ST
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81501-7434
Country	:	US
Telephone Number	:	970-243-1331
Fax Number	:	970-243-9190

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	TAMARA RUYBAL
Credential	:
Telephone Number	:	970-243-1331

Provider Enumeration Date	:	07/08/2009
Last Update Date	:	12/27/2010

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