Healthcare Provider Details

I. General information

NPI: 1821183286
Provider Name (Legal Business Name): DAVID WAYNE JOLLEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE 2-112
TUCSON AZ
85723
US

IV. Provider business mailing address

3601 S 6TH AVE # 2-112B
TUCSON AZ
85723-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax: 520-629-1706
Mailing address:
  • Phone: 520-792-1450
  • Fax: 520-629-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number286416-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: