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General NPI Number Information
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NPI Number | 1952441008
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Entity Type | Organization
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Legal Business Name | DAISY MOUNTAIN SURGICAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3654 W ANTHEM WAY SUITE B102
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City | ANTHEM
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State | AZ
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Zip | 85086-0455
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Country | US
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Telephone | 623-551-3280
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Fax | 623-551-3180
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Provider Business Mailing Address
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Address Line | 3434 W ANTHEM WAY SUITE 118-464
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City | ANTHEM
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State | AZ
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Zip | 85086-0448
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Country | US
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Telephone | 623-551-3280
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Fax | 623-551-3180
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN COOPER BORJESON
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Credential | D.O.
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Telephone | 623-551-3280
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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 | 3567
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License Number State | AZ
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