Individual
DR. JAMES NICHOLAS YARUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4824 E BASELINE RD, SUITE 140, MESA, AZ 85206-4678
(480) 969-4040
(480) 830-1042
Mailing address
4824 E BASELINE RD, SUITE 140, MESA, AZ 85206-4678
(480) 969-4040
(480) 830-1042
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
31732
AZ
2083X0100X
Occupational Medicine Physician
31732
AZ
208D00000X
General Practice Physician
Primary
31732
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106567
WASHINGTON LABOR & INDUSTRY
—
05
—
756430
—
AZ
01
—
Z90122
PTAN
AZ
Enumeration date
06/13/2012
Last updated
01/11/2016
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