Provider Demographics
NPI:1366426488
Name:PHILLIPS JONES, CONNIE (MD)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:PHILLIPS JONES
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 1:9180 EAST DESERT COVE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6742
Mailing Address - Country:US
Mailing Address - Phone:480-860-4791
Mailing Address - Fax:520-572-7138
Practice Address - Street 1:9180 EAST DESERT COVE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6742
Practice Address - Country:US
Practice Address - Phone:480-860-4791
Practice Address - Fax:520-572-7138
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ330232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ868680Medicaid
AZ105291Medicare PIN
G45001Medicare UPIN
AZ105292Medicare PIN
AZ105293Medicare PIN