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General NPI Number Information
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NPI Number | 1063781797
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Entity Type | Individual
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Provider Name | JASON PERNELL HEAVENS MD
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Gender | Male
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Dates
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Enumeration Date | 12/27/2011
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 4450 S RURAL RD STE A210
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City | TEMPE
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State | AZ
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Zip | 85282-5587
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Country | US
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Telephone | 623-444-2734
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Fax | 623-444-2784
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Provider Business Mailing Address
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Address Line | 105 S DELAWARE DR STE 1
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City | APACHE JUNCTION
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State | AZ
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Zip | 85120-6512
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Country | US
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Telephone | 623-444-2734
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Fax | 623-444-2784
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 44336
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 44336
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License Number State | AZ
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