Provider Demographics
NPI:1073678553
Name:VARGAS, JASON DANIEL (MD)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:DANIEL
Last Name:VARGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5940 W UNION HILLS DR
Mailing Address - Street 2:SUITE D-100
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1308
Mailing Address - Country:US
Mailing Address - Phone:602-978-2500
Mailing Address - Fax:602-938-2198
Practice Address - Street 1:5940 W UNION HILLS DR
Practice Address - Street 2:SUITE D-100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1308
Practice Address - Country:US
Practice Address - Phone:602-978-2500
Practice Address - Fax:602-938-2198
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ32657208000000X
CAA78630208000000X
WAML20006245208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ220616001Medicaid
H76595Medicare UPIN