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NPI Code Detail

MEDICARE: DAVID J JENDUSA M.D.

MEDICARE: DAVID J JENDUSA 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
12084P0800XPsychiatry Physician25847AZ

General Provider Information

NPI Number : 1730257874
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID J JENDUSA M.D.
Provider Business Mailing Address
First Line : 8050 E LAKESIDE PKWY
Second Line :
City : TUCSON
State : AZ
Zip : 85730-1254
Country : US
Telephone Number : 520-584-5820
Fax Number : 520-514-1514
Provider Business Practice Location Address
First Line : 8050 E LAKESIDE PKWY
Second Line :
City : TUCSON
State : AZ
Zip : 85730-1254
Country : US
Telephone Number : 520-584-5820
Fax Number : 520-514-1514
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2006
Last Update Date : 07/08/2007

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