Provider Demographics
NPI:1245315795
Name:HASSMAN, JERI BARBARA (MD)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:BARBARA
Last Name:HASSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S CRAYCROFT RD STE 400
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3834
Mailing Address - Country:US
Mailing Address - Phone:520-319-1919
Mailing Address - Fax:520-917-2040
Practice Address - Street 1:250 S CRAYCROFT RD STE 400
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3834
Practice Address - Country:US
Practice Address - Phone:520-319-1919
Practice Address - Fax:520-917-2040
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16132208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ860589137OtherFEIN NUMBER
AZC99618Medicare UPIN
AZZ69041Medicare PIN