Provider Demographics
NPI:1780634204
Name:SINGH, JAGPREET (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JAGPREET
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17014 W BELL RD
Mailing Address - Street 2:101
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2479
Mailing Address - Country:US
Mailing Address - Phone:623-584-1962
Mailing Address - Fax:623-388-3430
Practice Address - Street 1:17014 W BELL RD
Practice Address - Street 2:101
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2479
Practice Address - Country:US
Practice Address - Phone:623-584-1962
Practice Address - Fax:623-388-3430
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3355363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZQ59775Medicare UPIN