Provider Demographics
NPI:1326099615
Name:MACIAS, JESUS CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:CARLOS
Last Name:MACIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3200 E CAMELBACK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2327
Mailing Address - Country:US
Mailing Address - Phone:602-933-1814
Mailing Address - Fax:
Practice Address - Street 1:5983 E GRANT RD STE 117
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2366
Practice Address - Country:US
Practice Address - Phone:520-320-7999
Practice Address - Fax:520-320-9211
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ245092080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology