Healthcare Provider Details

I. General information

NPI: 1841273158
Provider Name (Legal Business Name): JESS P PRICE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7331 E OSBORN DR SUITE 230
SCOTTSDALE AZ
85251-6435
US

IV. Provider business mailing address

1301 S 7TH AVE 400
PHOENIX AZ
85007-3957
US

V. Phone/Fax

Practice location:
  • Phone: 480-292-9604
  • Fax: 480-292-9614
Mailing address:
  • Phone: 602-824-3379
  • Fax: 602-824-4117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01057218A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0673
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: