Provider Demographics
NPI:1154413763
Name:DILL, JANE ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELLEN
Last Name:DILL
Suffix:
Gender:F
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:PO BOX 3630
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-3630
Mailing Address - Country:US
Mailing Address - Phone:928-233-5110
Mailing Address - Fax:928-774-6687
Practice Address - Street 1:2920 N 4TH ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1816
Practice Address - Country:US
Practice Address - Phone:928-213-6100
Practice Address - Fax:928-774-4808
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ133667Medicare UPIN
AZZ121061Medicare UPIN
AZZ142168Medicare PIN
AZI00964Medicare UPIN
AZZ120963Medicare PIN
AZZ133668Medicare UPIN