Provider Demographics
NPI:1568508943
Name:JACQUEMART, CYNTHIA JEAN (MD)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:JEAN
Last Name:JACQUEMART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:JEAN
Other - Last Name:LARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5940 W UNION HILLS DR
Mailing Address - Street 2:SUITE D-100
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1308
Mailing Address - Country:US
Mailing Address - Phone:602-978-2500
Mailing Address - Fax:602-938-2198
Practice Address - Street 1:5940 W UNION HILLS DR
Practice Address - Street 2:SUITE D-100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1308
Practice Address - Country:US
Practice Address - Phone:602-978-2500
Practice Address - Fax:602-938-2198
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11450208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ215089001Medicaid