Provider Demographics
NPI:1952595431
Name:SANSTEAD, JERRY DON JR
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:DON
Last Name:SANSTEAD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14362 N FRANK LLOYD WRIGHT BLVD
Mailing Address - Street 2:SUITE B109
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-8846
Mailing Address - Country:US
Mailing Address - Phone:602-622-1934
Mailing Address - Fax:480-699-6413
Practice Address - Street 1:1063 N OPAL
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-2275
Practice Address - Country:US
Practice Address - Phone:480-205-9407
Practice Address - Fax:480-699-6413
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ883742174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist