Healthcare Provider Details

I. General information

NPI: 1225204381
Provider Name (Legal Business Name): JENNIFER EKDAHL CORTES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER SUSAN EKDAHL

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W UNIVERSITY AVE STE 101
FLAGSTAFF AZ
86001-2851
US

IV. Provider business mailing address

PO BOX 1231
TUCSON AZ
85702-1231
US

V. Phone/Fax

Practice location:
  • Phone: 928-522-1300
  • Fax: 928-522-1301
Mailing address:
  • Phone: 520-670-3909
  • Fax: 520-309-2560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43369
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43369
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: