Healthcare Provider Details

I. General information

NPI: 1033183017
Provider Name (Legal Business Name): JEFFREY DORIAN ISAACS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11209 N TATUM BLVD SUITE 260
PHOENIX AZ
85028-3091
US

IV. Provider business mailing address

PO BOX 6423
CHANDLER AZ
85246-6423
US

V. Phone/Fax

Practice location:
  • Phone: 602-494-6800
  • Fax: 602-494-6803
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number12959
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: