Healthcare Provider Details

I. General information

NPI: 1235391889
Provider Name (Legal Business Name): JEREMY K BINGHAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 E BROWN RD STE 28
MESA AZ
85213-4217
US

IV. Provider business mailing address

2855 E BROWN RD STE 28
MESA AZ
85213-4217
US

V. Phone/Fax

Practice location:
  • Phone: 480-625-4538
  • Fax:
Mailing address:
  • Phone: 480-625-4538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5198
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number5198
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: