Individual
JASON RICHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3931 E CAMELBACK RD, PHOENIX, AZ 85018-2609
(602) 687-7858
(602) 687-9276
Mailing address
12040 N 40TH WAY, PHOENIX, AZ 85028-1529
(602) 320-7557
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
005253
AZ
390200000X
Student in an Organized Health Care Education/Training Program
R931
AZ
Other
Enumeration date
12/27/2007
Last updated
12/30/2011
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