Provider Demographics
NPI:1023074317
Name:DANIELS, JASON B (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:B
Last Name:DANIELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40850
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85274
Mailing Address - Country:US
Mailing Address - Phone:480-839-3313
Mailing Address - Fax:480-839-4182
Practice Address - Street 1:5102 W CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031
Practice Address - Country:US
Practice Address - Phone:623-848-5000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30427207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAW1436OtherHEALTHNET GRP
AZAZ0728670OtherBLUE CROSS BLUE SHIELD GR
AZ3981220OtherEVERCARE GRP
AZ707482Medicaid
AZAW1436OtherHEALTHNET GRP
AZAZ0728670OtherBLUE CROSS BLUE SHIELD GR