Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 36143 | AZ |
N | 208600000X | Surgeon | 36143 | AZ |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 36143 | AZ |
NPI | 1154525715 |
---|---|
Provider Name | Dr. Jennifer Ann Geoghegan |
First Address | Scottsdale, AZ 85260-2217 |
Second Address | Scottsdale, AZ 85258-4581 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 15/10/2008 |