Provider Demographics
NPI:1881662351
Name:FONTIUS, JENNIFER JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JANE
Last Name:FONTIUS
Suffix:
Gender:F
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:PO BOX 28423
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0157
Mailing Address - Country:US
Mailing Address - Phone:480-563-3211
Mailing Address - Fax:480-563-5132
Practice Address - Street 1:7450 E PINNACLE PEAK RD
Practice Address - Street 2:SUITE 156
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3435
Practice Address - Country:US
Practice Address - Phone:480-563-3211
Practice Address - Fax:480-563-5132
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT201232475JJMOtherEDUCATORS MUTUAL
UTPRA07429OtherMOLINA
UT219182OtherALTIUS
UT79219OtherPEHP
UT107013333102OtherIHC-INTERMOUNTAIN HEALTHC
UTP00167591OtherMEDICARE RAILROAD
UTP3436838OtherOXFORD HEALTH PLANS
UT75493OtherDESERET MUTUAL BENEFIT
UT51981141202001OtherBLUE CROSS BLUE SHIELD
UTH72374Medicare UPIN
UTH72374Medicare UPIN