Individual
JASPER LAO PURACAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD MPH
Contact information
Practice address
1300 N 12TH ST STE 320, PHOENIX, AZ 85006-2858
(602) 521-3050
(602) 521-3046
Mailing address
1300 N 12TH ST STE 320, PHOENIX, AZ 85006-2858
(602) 521-3050
(602) 521-3046
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
70161
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/09/2021
Last updated
11/30/2023
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