Provider Demographics
NPI:1518919547
Name:MOHER, JENNIFER B (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:MOHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7507 E. TANQUE VERDE ROAD
Mailing Address - Street 2:101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715
Mailing Address - Country:US
Mailing Address - Phone:520-772-2585
Mailing Address - Fax:520-722-1097
Practice Address - Street 1:7507 E. TANQUE VERDE ROAD
Practice Address - Street 2:101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715
Practice Address - Country:US
Practice Address - Phone:520-772-2585
Practice Address - Fax:520-722-1097
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-07-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ32347208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ839699Medicaid
AZ839699Medicaid