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NPI Code Detail

MEDICARE: JARED LAVELL HAYMORE PA-C

MEDICARE: JARED LAVELL HAYMORE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant7381AZ

General Provider Information

NPI Number : 1316419641
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARED LAVELL HAYMORE PA-C
Provider Business Mailing Address
First Line : 5750 E HIGHWAY 90 STE 200
Second Line :
City : SIERRA VISTA
State : AZ
Zip : 85635-9113
Country : US
Telephone Number : 520-263-3500
Fax Number : 520-263-3599
Provider Business Practice Location Address
First Line : 5750 E HIGHWAY 90 STE 200
Second Line :
City : SIERRA VISTA
State : AZ
Zip : 85635-9113
Country : US
Telephone Number : 520-263-3500
Fax Number : 520-263-3599
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2018
Last Update Date : 12/27/2018

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Directions to “ JARED LAVELL HAYMORE PA-C” Practice Location

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