Individual
MR. JACOB A MATHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSN, CRNA
Contact information
Practice address
18701 N 67TH AVE, GLENDALE, AZ 85308-7100
(623) 561-1000
Mailing address
17632 N 114TH LN, SURPRISE, AZ 85378-6982
(480) 302-1286
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
264233
AZ
Other
Enumeration date
09/21/2021
Last updated
09/21/2021
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