Provider Demographics
NPI:1144575614
Name:PROSSER, JENNIFER S (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:S
Last Name:PROSSER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7021 E EARLL DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6321
Mailing Address - Country:US
Mailing Address - Phone:602-405-2305
Mailing Address - Fax:
Practice Address - Street 1:250 E DUNLAP AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2825
Practice Address - Country:US
Practice Address - Phone:602-870-6316
Practice Address - Fax:602-870-6091
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006528207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine