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General NPI Number Information
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NPI Number | 1063682524
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Entity Type | Organization
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Legal Business Name | JERITY ENTERPRISES, LLC
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 14362 N FRANK LLOYD WRIGHT BLVD SUITE B109
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-8846
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Country | US
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Telephone | 602-308-8383
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Fax | 480-699-6413
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Provider Business Mailing Address
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Address Line | 1063 N OPAL
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City | MESA
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State | AZ
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Zip | 85207-2275
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Country | US
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Telephone | 602-308-8383
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Fax | 480-699-6413
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Authorized Official
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Title or Position | MEMBER
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Name | MR. JERRY DON SANSTEAD JR.
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Credential |
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Telephone | 602-308-8383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 07625378E
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License Number State | AZ
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