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General NPI Number Information
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NPI Number | 1952595431
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Entity Type | Individual
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Provider Name | JERRY DON SANSTEAD JR.
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Gender | Male
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 08/28/2007
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Provider Practice Location 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 | 480-205-9407
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Fax | 480-699-6413
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Provider Business Mailing 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 | 602-622-1934
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Fax | 480-699-6413
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 883742
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License Number State | AZ
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