Individual
DR. NICHOLAS XAVIER JEBAILY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4444 N 32ND ST STE 175, PHOENIX, AZ 85018-3999
(602) 952-0002
(602) 224-9119
Mailing address
4444 N 32ND ST STE 175, PHOENIX, AZ 85018-3999
(602) 952-0002
(602) 224-9119
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2013-01215
NC
207RC0000X
Cardiovascular Disease Physician
49154
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710206909
—
NC
05
—
Q0121S
—
SC
Enumeration date
05/27/2010
Last updated
07/21/2022
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