Healthcare Provider Details

I. General information

NPI: 1134121874
Provider Name (Legal Business Name): CHARLES M.T. JOST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 03/17/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7529 E BROADWAY RD STE 101
MESA AZ
85208-2007
US

IV. Provider business mailing address

7529 E BASELINE SUITE 101
MESA AZ
85208
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-4343
  • Fax: 480-945-4350
Mailing address:
  • Phone: 480-945-4343
  • Fax: 480-945-4350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number28064
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number28064
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: