Healthcare Provider Details

I. General information

NPI: 1164659314
Provider Name (Legal Business Name): JENNIFER M ESCHBACHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

IV. Provider business mailing address

PO BOX 42210
PHOENIX AZ
85080-2210
US

V. Phone/Fax

Practice location:
  • Phone: 602-943-9200
  • Fax:
Mailing address:
  • Phone: 623-266-7770
  • Fax: 623-322-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number37732
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number37732
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: