NPIMap

Organization Active NPI

Tucson Dermatology LTD

  • Dermatology Physician
  • Tucson, AZ
National Provider Identifier
1992754824
Registry record updated Apr 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
8592 Issued in AZ
Legal business name
TUCSON DERMATOLOGY LTD
Practice address
6640 E Carondelet Dr
Tucson, AZ 85710-2119
Phone
(520) 886-4199
Fax
(520) 886-3114
NPI assigned
May 8, 2006
Last updated
Apr 7, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2008

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

Authorized official

Name
William David Jacoby Jr., MD
Title
President of Tucson Dermatology LTD
Phone
(520) 886-4199

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 8592 AZ Primary
Dermatology Physician 207N00000X 6653 AZ
MOHS-Micrographic Surgery Physician 207ND0101X 6653 AZ

Addresses

Primary practice location

6640 E Carondelet Dr
Tucson, AZ 85710-2119

Mailing address

6640 E Carondelet Dr
Tucson, AZ 85710-2119
Phone (520) 886-4199

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040623000616 AZ Part B Supplier - Clinic/Group Practice 9032194030 Receives reassigned benefits from 4 practitioners
Practice locations: Oro Valley, AZ; Tucson, AZ

National Provider Directory

National Provider Directory

Locations

6565 E Carondelet Dr
Ste 145
Tucson, AZ 85710
Phone (520) 886-4199

6640 E Carondelet Dr
Tucson, AZ 85710
Phone (520) 886-4199

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207526400000",
    "number": "1992754824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6640 E CARONDELET DR",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857102119",
            "telephone_number": "520-886-4199",
            "fax_number": "520-886-3114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6640 E CARONDELET DR",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857102119",
            "telephone_number": "520-886-4199",
            "fax_number": "520-886-3114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUCSON DERMATOLOGY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2008-04-07",
        "status": "A",
        "authorized_official_last_name": "JACOBY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT OF TUCSON DERMATOLOGY LTD",
        "authorized_official_telephone_number": "520-886-4199",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "8592",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "6653",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "AZ",
            "license": "6653",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.