Healthcare Provider Details

I. General information

NPI: 1063086718
Provider Name (Legal Business Name): JASON G GARRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUMCP GENERAL SURGERY CENTER 1441 N 12TH STREET 2ND FLOOR
PHOENIX AZ
85006
US

IV. Provider business mailing address

2259 E GLENCOVE ST
MESA AZ
85213-4612
US

V. Phone/Fax

Practice location:
  • Phone: 602-521-5969
  • Fax: 602-521-5987
Mailing address:
  • Phone: 480-292-6816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR.0077205
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: