Healthcare Provider Details

I. General information

NPI: 1932173531
Provider Name (Legal Business Name): JACK R CAVALCANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 S DOBSON RD 106
MESA AZ
85202-4768
US

IV. Provider business mailing address

1432 S DOBSON RD 106
MESA AZ
85202-4768
US

V. Phone/Fax

Practice location:
  • Phone: 480-969-3637
  • Fax: 480-969-6568
Mailing address:
  • Phone: 480-969-3637
  • Fax: 480-969-6568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number13635
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: