Provider Demographics
NPI:1538301916
Name:T A JANTZ DO PC
Entity Type:Organization
Organization Name:T A JANTZ DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEOPHIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:JANTZ
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:480-656-0016
Mailing Address - Street 1:PO BOX 34120
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-4120
Mailing Address - Country:US
Mailing Address - Phone:775-747-5050
Mailing Address - Fax:775-326-8298
Practice Address - Street 1:16100 N 71ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2209
Practice Address - Country:US
Practice Address - Phone:480-656-0016
Practice Address - Fax:480-634-1723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4667208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty