Basic Information
| Provider Information | |||||||||
| NPI: | 1568698074 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCALISTER | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | EUGENE | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7301 E 2ND ST STE 206 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852515610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027617819 | ||||||||
| FaxNumber: | 8669392673 | ||||||||
| Practice Location | |||||||||
| Address1: | 7301 E 2ND ST STE 206 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852515610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6027617819 | ||||||||
| FaxNumber: | 6023247199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2009 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 0764 | AZ | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0131X | 0764 | AZ | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 213ES0103X | 0116021668 | VA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0103X | 36.003606 | OH | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0103X | 0764 | AZ | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 795773 | 05 | AZ | MEDICAID |