Provider Demographics
NPI:1114345006
Name:LAW, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:LAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 E WARNER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3495
Mailing Address - Country:US
Mailing Address - Phone:480-393-0309
Mailing Address - Fax:480-610-6189
Practice Address - Street 1:2222 EAST ST STE 305
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2066
Practice Address - Country:US
Practice Address - Phone:925-686-1230
Practice Address - Fax:925-686-8443
Is Sole Proprietor?:No
Enumeration Date:2014-03-29
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA148326207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology