Basic Information
| Provider Information | |||||||||
| NPI: | 1386865780 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERKOWITZ | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14541 W INDIAN SCHOOL RD | ||||||||
| Address2: | STE 600 | ||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853959243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235355599 | ||||||||
| FaxNumber: | 6235354696 | ||||||||
| Practice Location | |||||||||
| Address1: | 14541 W INDIAN SCHOOL RD | ||||||||
| Address2: | STE 600 | ||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853959243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235355599 | ||||||||
| FaxNumber: | 6235354696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 05/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 41075 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 41075 | AZ | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 431499 | 05 | AZ | MEDICAID |