Healthcare Provider Details

I. General information

NPI: 1902138860
Provider Name (Legal Business Name): JASON D REDD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21300 N JOHN WAYNE PKWY UNIT 120
MARICOPA AZ
85139-8979
US

IV. Provider business mailing address

PO BOX 16297
BEVERLY HILLS CA
90209-2297
US

V. Phone/Fax

Practice location:
  • Phone: 623-253-9550
  • Fax:
Mailing address:
  • Phone: 800-991-6448
  • Fax: 424-369-9555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11155
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: