Provider Demographics
NPI:1043264633
Name:ELNADRY, JEANNE NOTTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:NOTTO
Last Name:ELNADRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2244 S AVENUE A
Mailing Address - Street 2:SUITE A
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8341
Mailing Address - Country:US
Mailing Address - Phone:928-276-4477
Mailing Address - Fax:928-276-4481
Practice Address - Street 1:2244 S AVENUE A
Practice Address - Street 2:SUITE A
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8341
Practice Address - Country:US
Practice Address - Phone:928-276-4477
Practice Address - Fax:928-276-4481
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21613207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD73894Medicare UPIN
AZ107529Medicare PIN