Healthcare Provider Details

I. General information

NPI: 1689658163
Provider Name (Legal Business Name): JEAN M. AMON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S AVENUE A
YUMA AZ
85364-7170
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7127
US

V. Phone/Fax

Practice location:
  • Phone: 928-336-3213
  • Fax:
Mailing address:
  • Phone: 928-344-2000
  • Fax: 928-722-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33054
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: