Provider Demographics
NPI:1386714822
Name:JEAN LUDGER AMAZAN MD PLC
Entity type:Organization
Organization Name:JEAN LUDGER AMAZAN MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:LUDGER
Authorized Official - Last Name:AMAZAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-793-1743
Mailing Address - Street 1:PO BOX 94568
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85070-4568
Mailing Address - Country:US
Mailing Address - Phone:480-361-7680
Mailing Address - Fax:480-361-7683
Practice Address - Street 1:1976 E BASELINE RD
Practice Address - Street 2:STE 102
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1533
Practice Address - Country:US
Practice Address - Phone:480-237-8255
Practice Address - Fax:480-413-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ105871Medicare PIN