MEDICARE: PARVIN MODABER JACOBS 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	207R00000X	Internal Medicine Physician	2083	NV

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
2	NV2083	OTHER	NV	BCROSS-BSHIELD PROV#

General Provider Information

NPI Number	:	1669545240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARVIN MODABER JACOBS M.D.

Provider Business Mailing Address
First Line	:	2870 S MARYLAND PKWY
Second Line	:	SUITE 300
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-5031
Country	:	US
Telephone Number	:	702-735-0258
Fax Number	:	702-735-9140

Provider Business Practice Location Address
First Line	:	2870 S MARYLAND PKWY
Second Line	:	SUITE 300
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-5031
Country	:	US
Telephone Number	:	702-735-0258
Fax Number	:	702-735-9140

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	10/29/2012

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Directions to “ PARVIN MODABER JACOBS M.D.” Practice Location

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