Healthcare Provider Details

I. General information

NPI: 1548263825
Provider Name (Legal Business Name): JUGROOP S BRAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14961 W BELL RD SUITE 175
SURPRISE AZ
85374-3200
US

IV. Provider business mailing address

14961 W BELL RD SUITE 175
SURPRISE AZ
85374-3200
US

V. Phone/Fax

Practice location:
  • Phone: 623-242-9830
  • Fax: 623-243-6733
Mailing address:
  • Phone: 623-242-9830
  • Fax: 623-243-6733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number34967
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number34967
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number34967
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: