Provider Demographics
NPI:1477828465
Name:JEAN, MARIE RAPHAELLE MONA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARIE RAPHAELLE
Middle Name:MONA
Last Name:JEAN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:BANNER UNIVERSITY MEDICAL CENTER
Mailing Address - Street 2:PO BOX 245073
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724
Mailing Address - Country:US
Mailing Address - Phone:520-626-5959
Mailing Address - Fax:520-626-4141
Practice Address - Street 1:1625 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719
Practice Address - Country:US
Practice Address - Phone:520-626-5959
Practice Address - Fax:520-626-4141
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD449257208000000X
AZ55190208000000X, 2080P0206X
OH35.1231822080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics