Provider Demographics
NPI:1184653107
Name:JESSOP, DARRELL JAMES (MD)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:JAMES
Last Name:JESSOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6261 N LA CHOLLA BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3564
Mailing Address - Country:US
Mailing Address - Phone:520-575-5061
Mailing Address - Fax:520-878-9010
Practice Address - Street 1:6261 N LA CHOLLA BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3564
Practice Address - Country:US
Practice Address - Phone:520-575-5061
Practice Address - Fax:520-878-9010
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z105158Medicare ID - Type Unspecified
G13969Medicare UPIN