Healthcare Provider Details

I. General information

NPI: 1053555110
Provider Name (Legal Business Name): RYAN WESLEY JONES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14044 W CAMELBACK RD STE 226
LITCHFIELD PARK AZ
85340
US

IV. Provider business mailing address

14044 W CAMELBACK RD STE 226
LITCHFIELD PARK AZ
85340-9426
US

V. Phone/Fax

Practice location:
  • Phone: 623-233-1050
  • Fax: 623-215-7137
Mailing address:
  • Phone: 623-233-1050
  • Fax: 623-248-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number006421
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number873
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: