Healthcare Provider Details

I. General information

NPI: 1467438572
Provider Name (Legal Business Name): JOHN P NESTOR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 W 16TH ST SAFFORD COMMUNITY HEALTH CENTER
SAFFORD AZ
85546-4026
US

IV. Provider business mailing address

P.O. BOX 1625
PAGE AZ
86040-1625
US

V. Phone/Fax

Practice location:
  • Phone: 928-428-1500
  • Fax: 928-428-1555
Mailing address:
  • Phone: 928-645-9675
  • Fax: 928-645-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3915
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: