Provider Demographics
NPI:1609163542
Name:KAYCE, JASON A (DPM)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:KAYCE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 E SHEA BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4257
Mailing Address - Country:US
Mailing Address - Phone:480-705-9920
Mailing Address - Fax:888-872-0466
Practice Address - Street 1:4611 E SHEA BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4254
Practice Address - Country:US
Practice Address - Phone:480-705-9920
Practice Address - Fax:888-872-0466
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0790213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ944337Medicaid