Provider Demographics
NPI:1063086718
Name:GARRY, JASON G
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:G
Last Name:GARRY
Suffix:
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 1:2259 E GLENCOVE ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-4612
Mailing Address - Country:US
Mailing Address - Phone:480-292-6816
Mailing Address - Fax:
Practice Address - Street 1:BUMCP GENERAL SURGERY CENTER
Practice Address - Street 2:1441 N 12TH STREET 2ND FLOOR
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-521-5969
Practice Address - Fax:602-521-5987
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program