Provider Demographics
NPI:1174378673
Name:JOSEPH JEROME, MIREILLE (MD- PA)
Entity type:Individual
Prefix:DR
First Name:MIREILLE
Middle Name:
Last Name:JOSEPH JEROME
Suffix:
Gender:F
Credentials:MD- PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6859 E REMBRANDT AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-3630
Mailing Address - Country:US
Mailing Address - Phone:754-422-5700
Mailing Address - Fax:
Practice Address - Street 1:6859 E REMBRANDT AVE STE 117
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3630
Practice Address - Country:US
Practice Address - Phone:754-422-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1780363AM0700X
AZ10398207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical