Provider Demographics
NPI:1972531358
Name:ALTMAN, JERALD S (MD)
Entity type:Individual
Prefix:
First Name:JERALD
Middle Name:S
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18700 N 64TH DR
Mailing Address - Street 2:STE 201
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-7114
Mailing Address - Country:US
Mailing Address - Phone:623-566-4718
Mailing Address - Fax:623-566-4820
Practice Address - Street 1:18700 N 64TH DR
Practice Address - Street 2:STE 201
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7114
Practice Address - Country:US
Practice Address - Phone:623-566-4718
Practice Address - Fax:623-566-4820
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2012-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ26123207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ424565Medicaid
AZ424565Medicaid
G23769Medicare UPIN