Provider Demographics
NPI:1881806982
Name:SOKOLOV, JACQUE JENNING (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUE
Middle Name:JENNING
Last Name:SOKOLOV
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 1:5685 N SCOTTSDALE RD
Mailing Address - Street 2:E100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-5900
Mailing Address - Country:US
Mailing Address - Phone:480-707-4521
Mailing Address - Fax:
Practice Address - Street 1:5685 N SCOTTSDALE RD
Practice Address - Street 2:E100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-5900
Practice Address - Country:US
Practice Address - Phone:480-707-4521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33896207R00000X
CAG39470207R00000X
MN25099207R00000X
TXG0148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine