Provider Demographics
NPI:1972540367
Name:STECK, JEROME KEITH (DPM)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:KEITH
Last Name:STECK
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 1:6567 E CARONDELET DR
Mailing Address - Street 2:SUITE 415
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2156
Mailing Address - Country:US
Mailing Address - Phone:520-885-6701
Mailing Address - Fax:520-885-9037
Practice Address - Street 1:6567 E CARONDELET DR
Practice Address - Street 2:SUITE 415
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2156
Practice Address - Country:US
Practice Address - Phone:520-885-6701
Practice Address - Fax:520-885-9037
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0610213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU85841Medicare UPIN