Healthcare Provider Details

I. General information

NPI: 1932143658
Provider Name (Legal Business Name): DPMJONESNRAZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 E DARREL RD
PHOENIX AZ
85042-5227
US

IV. Provider business mailing address

4318 E DARREL RD
PHOENIX AZ
85042-5227
US

V. Phone/Fax

Practice location:
  • Phone: 484-653-7886
  • Fax:
Mailing address:
  • Phone: 484-653-7886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number0406
License Number StateAZ

VIII. Authorized Official

Name: NOLAND JONES
Title or Position: OWNER
Credential: DPM
Phone: 484-653-7886