Healthcare Provider Details

I. General information

NPI: 1023143302
Provider Name (Legal Business Name): JASON ROLFE KERR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N SCOTTSDALE RD SUITE 130
SCOTTSDALE AZ
85251-5648
US

IV. Provider business mailing address

9700 N 91ST ST SUITE C-200
SCOTTSDALE AZ
85258-5054
US

V. Phone/Fax

Practice location:
  • Phone: 480-425-5000
  • Fax: 480-425-5033
Mailing address:
  • Phone: 480-425-5000
  • Fax: 480-425-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number36829
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2003001822
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number2003001822
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number36829
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: