Provider Demographics
NPI:1104890193
Name:SOLOMON, JACQUELINE M (DO)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:M
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18205 N 51ST AVE
Mailing Address - Street 2:STE 133
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1490
Mailing Address - Country:US
Mailing Address - Phone:623-561-1151
Mailing Address - Fax:623-561-8454
Practice Address - Street 1:18205 N 51ST AVE
Practice Address - Street 2:STE 133
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1490
Practice Address - Country:US
Practice Address - Phone:623-561-1151
Practice Address - Fax:623-561-8454
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2379207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D47171Medicare UPIN
AZZ78068Medicare ID - Type Unspecified