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NPI Code Detail

MEDICARE: MISS JENNIFER DANIELLE GAITLEY M.D.

MEDICARE: MISS JENNIFER DANIELLE GAITLEY M.D.
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
1208000000XPediatrics Physician2017-02087NC
22080S0010XPediatric Sports Medicine Physician2017-02087NC
32080S0010XPediatric Sports Medicine Physician60285AZ

General Provider Information

NPI Number : 1528321569
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JENNIFER DANIELLE GAITLEY M.D.
Provider Business Mailing Address
First Line : 3200 E CAMELBACK RD STE 250
Second Line :
City : PHOENIX
State : AZ
Zip : 85018-2327
Country : US
Telephone Number : 602-933-1814
Fax Number : 602-933-8972
Provider Business Practice Location Address
First Line : 1919 E THOMAS RD FL 2
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-7710
Country : US
Telephone Number : 602-933-3033
Fax Number : 602-933-4311
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2012
Last Update Date : 12/10/2020

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