Provider Demographics
NPI:1689610800
Name:VAN BUREN, JEREMY J (MD, PHD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:J
Last Name:VAN BUREN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 E MISSOURI AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2718
Mailing Address - Country:US
Mailing Address - Phone:602-995-1166
Mailing Address - Fax:602-995-2390
Practice Address - Street 1:1130 E MISSOURI AVE
Practice Address - Street 2:STE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2718
Practice Address - Country:US
Practice Address - Phone:602-995-1166
Practice Address - Fax:602-995-2390
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ41479207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ155074Medicare PIN