Individual
DR. JASON E GITTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11045 N 19TH AVE, PHOENIX, AZ 85029-4816
(623) 849-1869
(623) 849-5880
Mailing address
12440 N 40TH DR, PHOENIX, AZ 85029-2969
(602) 588-7007
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
10754
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z152056
MEDICARE PTAN
AZ
Enumeration date
02/28/2007
Last updated
04/07/2016
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