Peckham, Jonathan Dale

Peckham, Jonathan Dale is an individual health care provider with primary practice located at 12361 W Bola Dr Ste 100 , Surprise AZ 85378-9021. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Peckham, Jonathan Dale can be contacted via phone (602) 641-9486.

Contact Information

Primary practice address
12361 W Bola Dr Ste 100 Surprise AZ 85378-9021
Phone: (602) 641-9486
Fax: (480) 500-8430
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 5479 Arizona

Profile Details

NPI number 1992130884
LBN Legal business name Peckham, Jonathan Dale
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 10th, 2013
Last updated Aug 27th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992130884 NPPES
Arizona MEDICAID 862609

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