Provider Demographics
NPI:1154525715
Name:GEOGHEGAN, JENNIFER ANN (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:GEOGHEGAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:15029 N THOMPSON PEAK PKWY
Mailing Address - Street 2:B111-603
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2217
Mailing Address - Country:US
Mailing Address - Phone:480-264-6428
Mailing Address - Fax:480-264-6429
Practice Address - Street 1:9590 E IRONWOOD SQUARE DR
Practice Address - Street 2:SUITE #108
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4581
Practice Address - Country:US
Practice Address - Phone:480-264-6428
Practice Address - Fax:480-264-6429
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2008-10-15
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Provider Licenses
StateLicense IDTaxonomies
AZ361432086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery