Healthcare Provider Details

I. General information

NPI: 1154525715
Provider Name (Legal Business Name): JENNIFER ANN GEOGHEGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9590 E IRONWOOD SQUARE DR SUITE #108
SCOTTSDALE AZ
85258-4581
US

IV. Provider business mailing address

15029 N THOMPSON PEAK PKWY B111-603
SCOTTSDALE AZ
85260-2217
US

V. Phone/Fax

Practice location:
  • Phone: 480-264-6428
  • Fax: 480-264-6429
Mailing address:
  • Phone: 480-264-6428
  • Fax: 480-264-6429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number36143
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number36143
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: