Individual
JASON THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1111 E MCDOWELL RD, PHOENIX, AZ 85006-2612
(480) 500-2540
(623) 201-7954
Mailing address
1000 10TH AVE, NEW YORK, NY 10019-1147
(212) 523-4000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
57122
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/03/2016
Last updated
06/10/2019
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