Active NPI
Ian Alexander Jeffer, ATC, LAT
- Athletic Trainer
- Mesa, AZ
National Provider Identifier
1477356095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- ATR-009548
- Practice address
- 10045 E Madero Ave
Mesa, AZ 85209-1399 - Phone
- (480) 415-4120
- NPI assigned
- Mar 29, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | ATR-009548 | AZ | Primary |
Addresses
Primary practice location
10045 E Madero Ave
Mesa, AZ 85209-1399
Mailing address
1725 S Coronado Rd Apt 3101
Gilbert, AZ 85295-0249
Phone (480) 415-4120
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ATR-009548 | AZ | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1743206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743206400000",
"number": "1477356095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1725 S CORONADO RD APT 3101",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852950249",
"telephone_number": "480-415-4120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10045 E MADERO AVE",
"city": "MESA",
"state": "AZ",
"postal_code": "852091399",
"telephone_number": "480-415-4120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEFFER",
"first_name": "IAN",
"middle_name": "ALEXANDER",
"credential": "ATC, LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-03-29",
"last_updated": "2025-03-29",
"certification_date": "2025-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AZ",
"license": "ATR-009548",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.