Provider Demographics
NPI:1609829506
Name:AMRANI, JACOB (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:AMRANI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2735 W UNION HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5033
Mailing Address - Country:US
Mailing Address - Phone:602-588-2225
Mailing Address - Fax:602-588-2226
Practice Address - Street 1:16557 N 109TH WAY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-2414
Practice Address - Country:US
Practice Address - Phone:623-866-8240
Practice Address - Fax:602-588-2226
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ35194204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE72610Medicare UPIN