Jacob David Gozdor

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

R80915 Issued in AZ

Practice address

707 N Alvernon Way
Tucson, AZ 85711-1827

Phone

(989) 583-0000

NPI assigned

Jun 26, 2022

Last updated

Apr 15, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1407588817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10106 DORCHESTER CT",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483482192",
            "telephone_number": "248-568-1886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N ALVERNON WAY",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857111827",
            "telephone_number": "989-583-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOZDOR",
        "first_name": "JACOB",
        "middle_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-26",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "G235356135366",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "R80915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juan Govea
• Karthikeyan Govindarajan, PHARM.D.
• Tina Gowan, CSFA
• Ninia Goyal, M.D.
• Uma Devi Goyal, M.D.
• Raymond Frederick Graap, M.D.
• Traci Lynn Grabb, LPC
• Stephen A. Grabenbauer, CRNA
• Emily Marie Graber, PSY.D.
• James Robert Grabill, LISAC

• Family Medicine Physician in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.