MEDICARE: JACOBO ARMANDO RUYBAL JR. 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

General Provider Information

NPI Number	:	1881766822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOBO ARMANDO RUYBAL JR. 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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	12/31/2009

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