Provider Demographics
NPI:1770541450
Name:ZUESS, JONATHAN GABRIEL (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:GABRIEL
Last Name:ZUESS
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 1:4545 EAST SHEA BLVD.
Mailing Address - Street 2:SUITE 174
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3061
Mailing Address - Country:US
Mailing Address - Phone:602-923-1694
Mailing Address - Fax:602-923-1913
Practice Address - Street 1:4545 EAST SHEA BLVD.
Practice Address - Street 2:SUITE 174
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3061
Practice Address - Country:US
Practice Address - Phone:602-923-1694
Practice Address - Fax:602-923-1913
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ291892084P0800X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ594970Medicaid
73652Medicare ID - Type Unspecified
AZ594970Medicaid