Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 006693 | AZ |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 006693 | AZ |
NPI | 1093009672 |
---|---|
Provider Name | Dr. Jason Scott Couch |
First Address | Mesa, AZ 85206-1826 |
Second Address | Phoenix, AZ 85021-2759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2011 |
Last Update Date | 30/07/2017 |