Provider Demographics
NPI:1053491050
Name:CHOWDHURY-JACKSON, ZEENAT (MD)
Entity Type:Individual
Prefix:DR
First Name:ZEENAT
Middle Name:
Last Name:CHOWDHURY-JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ZEENAT
Other - Middle Name:
Other - Last Name:CHOWDHURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:81 W ESPERANZA BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-2667
Mailing Address - Country:US
Mailing Address - Phone:520-625-4401
Mailing Address - Fax:520-625-8504
Practice Address - Street 1:15921 W AJO HWY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85735-2032
Practice Address - Country:US
Practice Address - Phone:520-407-5700
Practice Address - Fax:520-822-2335
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28573207R00000X
TXK8080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ790510Medicaid
AZH52484Medicare UPIN