Individual
JACOB MEDFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1204 E BASELINE RD STE 205, TEMPE, AZ 85283-1453
(619) 708-1440
Mailing address
44276 W NEELY DR, MARICOPA, AZ 85138-9427
(619) 708-1440
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
AZ
Other
Enumeration date
12/18/2021
Last updated
12/18/2021
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