Healthcare Provider Details

I. General information

NPI: 1508884594
Provider Name (Legal Business Name): JOHN CHARLES RIMER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST STE 3025
PHOENIX AZ
85020-2428
US

IV. Provider business mailing address

1202 E NICOLET AVE
PHOENIX AZ
85020-5119
US

V. Phone/Fax

Practice location:
  • Phone: 602-944-4628
  • Fax: 602-944-2805
Mailing address:
  • Phone: 602-679-3902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2524
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: