Individual
JEFFERY CARLETON NORTHUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5171 CUB LAKE ROAD, BLDG B SUITE 210, SHOW LOW, AZ 85901
(800) 344-8299
(928) 537-4437
Mailing address
5171 CUB LAKE ROAD, BLDG B SUITE 210, SHOW LOW, AZ 85901
(800) 344-8299
(928) 537-4437
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1447
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227654-02
—
AZ
Enumeration date
08/16/2006
Last updated
07/08/2007
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