Healthcare Provider Details

I. General information

NPI: 1780891135
Provider Name (Legal Business Name): JATINDER SINGH PUREWAL,MD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28416 N 25 TH DALE
PHOENIX AZ
85085-3721
US

IV. Provider business mailing address

28416 N 25 TH DALE
PHOENIX AZ
85085-3721
US

V. Phone/Fax

Practice location:
  • Phone: 623-521-6785
  • Fax:
Mailing address:
  • Phone: 623-521-6785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License Number36732
License Number StateAZ

VIII. Authorized Official

Name: DR. JATINDER SINGH PUREWAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 623-521-6785