Healthcare Provider Details

I. General information

NPI: 1548255516
Provider Name (Legal Business Name): JAMIE HARRIS KAPNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10250 N 92ND ST SUITE 118
SCOTTSDALE AZ
85258-4510
US

IV. Provider business mailing address

10250 N 92ND ST SUITE 118
SCOTTSDALE AZ
85258-4510
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-6486
  • Fax: 480-860-0896
Mailing address:
  • Phone: 480-860-6486
  • Fax: 480-860-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number14167
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: