Individual
JAY M BRASHEAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTRL
Contact information
Practice address
2200 E SHOW LOW LAKE RD, SHOW LOW, AZ 85901-7831
(928) 537-4375
Mailing address
4807 DEER VLY, LAKESIDE, AZ 85929-5200
(480) 710-7487
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2401
AZ
Other
Enumeration date
05/22/2007
Last updated
09/26/2012
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