Provider Demographics
NPI:1275512352
Name:KATZ, JEFFREY STUART (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STUART
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1715 W NORTHERN AVE
Mailing Address - Street 2:108
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5472
Mailing Address - Country:US
Mailing Address - Phone:602-395-0718
Mailing Address - Fax:602-277-8146
Practice Address - Street 1:1715 W NORTHERN AVE
Practice Address - Street 2:108
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5472
Practice Address - Country:US
Practice Address - Phone:602-395-0718
Practice Address - Fax:602-277-8146
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ22827207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ425860Medicaid
AZF38549Medicare UPIN
AZ425860Medicaid