Healthcare Provider Details

I. General information

NPI: 1427043165
Provider Name (Legal Business Name): JOHN TASSONE JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 W THUNDERBIRD RD SUITE G-2
GLENDALE AZ
85306-4636
US

IV. Provider business mailing address

5620 W THUNDERBIRD RD SUITE F-1
GLENDALE AZ
85306-4636
US

V. Phone/Fax

Practice location:
  • Phone: 602-938-6960
  • Fax: 602-938-6069
Mailing address:
  • Phone: 602-938-6960
  • Fax: 602-938-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0466
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: