Provider Demographics
NPI:1548780273
Name:GAGNON, JEAN-PHILLIPPE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN-PHILLIPPE
Middle Name:
Last Name:GAGNON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 W 24TH ST APT 128
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6065
Mailing Address - Country:US
Mailing Address - Phone:506-962-2176
Mailing Address - Fax:
Practice Address - Street 1:2451 S AVENUE A STE C101
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7360
Practice Address - Country:US
Practice Address - Phone:928-336-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1908R76444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine