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General NPI Number Information
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NPI Number | 1205039666
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Entity Type | Organization
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Legal Business Name | JENNIFER FONTIUS MD PLLC
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 7450 E PINNACLE PEAK RD SUITE 156
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-3435
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Country | US
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Telephone | 480-563-3211
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Fax | 480-563-5132
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Provider Business Mailing Address
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Address Line | PO BOX 28423
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-0157
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Country | US
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Telephone | 480-563-3211
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Fax | 480-563-5132
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER JANE FONTIUS
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Credential | MD
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Telephone | 602-516-5244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 35692
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License Number State | AZ
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