Individual provider · NPI-1

Jason Anderson

Family Medicine · Phoenix, AZ

NPI number1073947115
StatusActive
Last updated in NPPESSep 29, 2025

Details

NPI
1073947115
Entity type
Individual (NPI-1)
Name
Jason Anderson
Sex
Male
Sole proprietor
No
Enumeration date
Aug 26, 2013
Certification date
Sep 29, 2025
Last updated
Sep 29, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine64164AZYes
171M00000X Case Manager/Care Coordinator––
390200000X Student in an Organized Health Care Education/Training Program––

Practice location

2500 W Utopia Rd Ste 100
Phoenix, AZ 85027-4172

Phone 623-295-4820

Mailing address

2500 W Utopia Rd Ste 100
Phoenix, AZ 85027-4172

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