Individual
MR. JACK NATHAN POLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9100 N 2ND ST, SUITE 121, PHOENIX, AZ 85020-2446
(602) 997-7331
(602) 870-4512
Mailing address
2500 W UTOPIA RD, STE. 100, PHOENIX, AZ 85027-4171
(602) 214-6148
(602) 214-6149
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
AP6412085
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41884
BOARD CERT #
AZ
Enumeration date
11/16/2005
Last updated
09/24/2013
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