Healthcare Provider Details

I. General information

NPI: 1386714822
Provider Name (Legal Business Name): JEAN LUDGER AMAZAN MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1976 E BASELINE RD STE 102
TEMPE AZ
85283-1533
US

IV. Provider business mailing address

PO BOX 94568
PHOENIX AZ
85070-4568
US

V. Phone/Fax

Practice location:
  • Phone: 480-237-8255
  • Fax: 480-413-1153
Mailing address:
  • Phone: 480-361-7680
  • Fax: 480-361-7683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. JEAN LUDGER AMAZAN
Title or Position: PRESIDENT
Credential: MD
Phone: 602-793-1743