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General NPI Number Information
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NPI Number | 1114107323
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Entity Type | Organization
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Legal Business Name | T.A. JANTZ, D.O., P.C.
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 1008 E MCDOWELL RD
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City | PHOENIX
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State | AZ
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Zip | 85006-2603
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Country | US
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Telephone | 602-258-7003
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Fax | 602-254-3474
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Provider Business Mailing Address
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Address Line | 1008 E MCDOWELL RD
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City | PHOENIX
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State | AZ
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Zip | 85006-2603
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Country | US
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Telephone | 602-258-7003
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Fax | 602-254-3474
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. THEOPHIL JANTZ
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Credential | D.O.
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Telephone | 602-258-7003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4667
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License Number State | AZ
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