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General NPI Number Information
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NPI Number | 1093009672
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Entity Type | Individual
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Provider Name | JASON SCOTT COUCH D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 07/30/2017
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Provider Practice Location Address
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Address Line | 2510 W DUNLAP AVE STE 290 SUITE # 290
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City | PHOENIX
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State | AZ
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Zip | 85021-2759
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Country | US
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Telephone | 602-789-0344
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Fax |
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Provider Business Mailing Address
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Address Line | 3829 E DEWBERRY AVE
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City | MESA
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State | AZ
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Zip | 85206-1826
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Country | US
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Telephone | 480-381-3103
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 006693
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 006693
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License Number State | AZ
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