Healthcare Provider Details

I. General information

NPI: 1972563955
Provider Name (Legal Business Name): JASON C HARRILL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S DOBSON RD STE 307
MESA AZ
85202-4725
US

IV. Provider business mailing address

1520 S DOBSON RD STE 307
MESA AZ
85202-4725
US

V. Phone/Fax

Practice location:
  • Phone: 480-844-8218
  • Fax: 480-844-9950
Mailing address:
  • Phone: 480-844-8218
  • Fax: 480-844-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0539
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: