Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 3768 | AZ |
Y | 111NN0400X | Neurology | AZ3768 | AZ |
NPI | 1255470753 |
---|---|
Provider Name | Dr. B Jeffrey Jolley |
First Address | Mesa, AZ 85210-6887 |
Second Address | Mesa, AZ 85210-6887 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 23/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T41789 | (02) | AZ |