Provider Demographics
NPI:1528280583
Name:REITZ, JENNIFER NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NICOLE
Last Name:REITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2320 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1303
Mailing Address - Country:US
Mailing Address - Phone:602-258-9900
Mailing Address - Fax:602-258-9904
Practice Address - Street 1:3367 S. MERCY RD
Practice Address - Street 2:#210
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
Practice Address - Country:US
Practice Address - Phone:480-969-4138
Practice Address - Fax:480-969-0630
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAML20008017208600000X
AZ41944208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery