Provider Demographics
NPI:1225281744
Name:GENERATIONS FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:GENERATIONS FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-988-4645
Mailing Address - Street 1:3336 E CHANDLER HEIGHTS RD STE 113
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4263
Mailing Address - Country:US
Mailing Address - Phone:480-988-4645
Mailing Address - Fax:480-988-4745
Practice Address - Street 1:3336 E CHANDLER HEIGHTS RD STE 113
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4263
Practice Address - Country:US
Practice Address - Phone:480-988-4645
Practice Address - Fax:480-988-4745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH46647Medicare UPIN