Provider Demographics
NPI:1073618161
Name:LEDESMA, JAIME M (MD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:M
Last Name:LEDESMA
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5055 E BROADWAY BLVD STE A100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3629
Mailing Address - Country:US
Mailing Address - Phone:520-382-1205
Mailing Address - Fax:
Practice Address - Street 1:1261 N WILMOT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5154
Practice Address - Country:US
Practice Address - Phone:520-722-6858
Practice Address - Fax:520-722-8781
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ16286207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ285503Medicaid
AZ74852Medicare ID - Type Unspecified
AZ285503Medicaid