| Doctor Name: | JOHN DESJARLAIS |
| NPI Number: | 1053703199 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 500 N Us Highway 89 Prescott, AZ - 863135001 |
| Business Phone Number: | 9254454860 |
| Business Fax Number: | |
| Mailing Address: | 500 N Us Highway 89, PRESCOTT |
| State: | AZ |
| Postal Code: | 863135001 |
| Phone Number: | 9254454860 |
| Fax Number: | |
| NPI Enumeration Date: | 02/26/2015 |
| NPI Last Update Date: | 02/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246QM0706X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Spec/Tech, Pathology |
| Taxonomy Specialization: | Medical Technologist |
| Taxonomy Definition: | |