Healthcare Provider Details

I. General information

NPI: 1215211255
Provider Name (Legal Business Name): JOHN ALLEN SAUMS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 S HOSPITAL DR
GLOBE AZ
85501-9447
US

IV. Provider business mailing address

PO BOX 52707
PHOENIX AZ
85072-2707
US

V. Phone/Fax

Practice location:
  • Phone: 928-425-3261
  • Fax:
Mailing address:
  • Phone: 866-321-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4984
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: