Healthcare Provider Details

I. General information

NPI: 1326740077
Provider Name (Legal Business Name): DEREK CHARLES JEZULIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E AJO WAY
TUCSON AZ
85713-6204
US

IV. Provider business mailing address

2800 E AJO WAY
TUCSON AZ
85713-6204
US

V. Phone/Fax

Practice location:
  • Phone: 520-874-2000
  • Fax:
Mailing address:
  • Phone: 520-874-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number012351
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number012351
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: