Provider Demographics
NPI:1720050164
Name:APPLEFELD, JACK J (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:J
Last Name:APPLEFELD
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 1:7449 E OSBORN RD
Mailing Address - Street 2:#7
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6448
Mailing Address - Country:US
Mailing Address - Phone:480-947-1130
Mailing Address - Fax:480-947-1132
Practice Address - Street 1:7449 E OSBORN RD
Practice Address - Street 2:#7
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6448
Practice Address - Country:US
Practice Address - Phone:480-947-1130
Practice Address - Fax:480-947-1132
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14425207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ38104Medicaid
AZ38104Medicaid
106598Medicare ID - Type Unspecified