Healthcare Provider Details

I. General information

NPI: 1609829506
Provider Name (Legal Business Name): JACOB AMRANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16557 N 109TH WAY
SCOTTSDALE AZ
85255-2414
US

IV. Provider business mailing address

2735 W UNION HILLS DR
PHOENIX AZ
85027-5033
US

V. Phone/Fax

Practice location:
  • Phone: 623-866-8240
  • Fax: 602-588-2226
Mailing address:
  • Phone: 602-588-2225
  • Fax: 602-588-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number35194
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: