Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 7414 | AZ |
NPI | 1083914261 |
---|---|
Provider Name | Kortni R Jones |
First Address | Phoenix, AZ 85013-3115 |
Second Address | Phoenix, AZ 85003-1214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2010 |
Last Update Date | 06/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5601005908 | STATE OF MI LIC (01) | MI |