Individual
STEPHANIE L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10900 N SCOTTSDALE RD, SUITE 603, SCOTTSDALE, AZ 85254-5216
(480) 882-7470
(480) 922-2472
Mailing address
2500 W UTOPIA RD, SUITE 100, PHOENIX, AZ 85027-4171
(623) 434-6200
(623) 434-6164
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
51415
AZ
207R00000X
Internal Medicine Physician
MD23663
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120461
—
AZ
05
—
286902
—
OR
Enumeration date
01/25/2006
Last updated
07/25/2016
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