Provider Demographics
NPI:1366622466
Name:TAIT, JONATHAN DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:TAIT
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:7790 N ORACLE RD STE 150
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6589
Mailing Address - Country:US
Mailing Address - Phone:520-777-9385
Mailing Address - Fax:
Practice Address - Street 1:7790 N ORACLE RD STE 150
Practice Address - Street 2:SUITE 150
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85704-6589
Practice Address - Country:US
Practice Address - Phone:520-777-9385
Practice Address - Fax:520-306-4843
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2014-02-28
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Provider Licenses
StateLicense IDTaxonomies
AZ0055032081S0010X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ145821Medicare UPIN