Provider Demographics
NPI:1255623732
Name:RILEY, JARRETT EDWARD STEWART (DO)
Entity type:Individual
Prefix:
First Name:JARRETT
Middle Name:EDWARD STEWART
Last Name:RILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9780 S ESTRELLA PKWY
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-7114
Mailing Address - Country:US
Mailing Address - Phone:623-474-8101
Mailing Address - Fax:623-474-8135
Practice Address - Street 1:9780 S ESTRELLA PKWY
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-7114
Practice Address - Country:US
Practice Address - Phone:623-474-8101
Practice Address - Fax:623-474-8135
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0862208000000X
WAOP60536051208000000X
AZ008756208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics