Provider Demographics
NPI:1205039666
Name:JENNIFER FONTIUS MD PLLC
Entity Type:Organization
Organization Name:JENNIFER FONTIUS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:FONTIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-516-5244
Mailing Address - Street 1:PO BOX 28423
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0157
Mailing Address - Country:US
Mailing Address - Phone:480-563-3211
Mailing Address - Fax:480-563-5132
Practice Address - Street 1:7450 E PINNACLE PEAK RD
Practice Address - Street 2:SUITE 156
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3435
Practice Address - Country:US
Practice Address - Phone:480-563-3211
Practice Address - Fax:480-563-5132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35692261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH72374Medicare UPIN