Provider Demographics
NPI:1114945201
Name:JONES, SUSAN J (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 S 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-4011
Mailing Address - Country:US
Mailing Address - Phone:928-428-1377
Mailing Address - Fax:928-348-8570
Practice Address - Street 1:1680 S 20TH AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-4011
Practice Address - Country:US
Practice Address - Phone:928-428-1377
Practice Address - Fax:928-348-8570
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ238461Medicaid
AZAZ0251850OtherBCBS PROVIDER ID
AZZ08WCHWP01Medicare ID - Type Unspecified
AZC04240Medicare UPIN