Individual
JASON FORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CST/CSA
Contact information
Practice address
2778 E SUPERIOR RD, SAN TAN VALLEY, AZ 85143-4573
(480) 313-9045
(480) 987-2186
Mailing address
2778 E SUPERIOR RD, SAN TAN VALLEY, AZ 85143-4573
(480) 313-9045
(480) 987-2186
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
454110172
OR
246ZS0410X
Surgical Technologist
Primary
L18709787
AZ
Other
Enumeration date
01/16/2012
Last updated
08/12/2014
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