Healthcare Provider Details

I. General information

NPI: 1467292615
Provider Name (Legal Business Name): JEFFREY DANIEL MUTTERPERL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18701 N 67TH AVE
GLENDALE AZ
85308-7100
US

IV. Provider business mailing address

18701 N 67TH AVE
GLENDALE AZ
85308-7100
US

V. Phone/Fax

Practice location:
  • Phone: 623-561-1000
  • Fax:
Mailing address:
  • Phone: 623-561-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR4811
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: