Provider Demographics
NPI:1063781797
Name:HEAVENS, JASON PERNELL (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:PERNELL
Last Name:HEAVENS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:105 S DELAWARE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-6512
Mailing Address - Country:US
Mailing Address - Phone:623-444-2734
Mailing Address - Fax:623-444-2784
Practice Address - Street 1:4450 S RURAL RD STE A210
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5587
Practice Address - Country:US
Practice Address - Phone:623-444-2734
Practice Address - Fax:623-444-2784
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2025-11-13
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Provider Licenses
StateLicense IDTaxonomies
AZ44336207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine