Individual
WILLIAM T. JACOBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6424 E BROADWAY RD STE 101, MESA, AZ 85206-1750
(480) 456-9000
Mailing address
1201 S ALMA SCHOOL RD, SUITE 14000, MESA, AZ 85210-2008
(480) 545-8119
(480) 926-8332
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
22425
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165177
—
AZ
01
—
Z123768
MEDICARE ID FOR EVAC, LLC
—
Enumeration date
10/14/2005
Last updated
01/31/2019
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