Provider Demographics
NPI:1518019694
Name:KING, JENNIFER BUZZELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BUZZELL
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:RAYE
Other - Last Name:BUZZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6480 N REGAL MANOR DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1061
Mailing Address - Country:US
Mailing Address - Phone:520-869-4998
Mailing Address - Fax:520-989-3452
Practice Address - Street 1:120 S HOUGHTON RD STE 138-150
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85748-6731
Practice Address - Country:US
Practice Address - Phone:520-869-4998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35741207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ439590Medicaid