Basic Information
| Provider Information | |||||||||
| NPI: | 1053491050 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHOWDHURY-JACKSON | ||||||||
| FirstName: | ZEENAT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CHOWDHURY | ||||||||
| OtherFirstName: | ZEENAT | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 81 W ESPERANZA BLVD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | GREEN VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856142667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206254401 | ||||||||
| FaxNumber: | 5206258504 | ||||||||
| Practice Location | |||||||||
| Address1: | 15921 W AJO HWY | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857352032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204075700 | ||||||||
| FaxNumber: | 5208222335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 03/04/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 28573 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | K8080 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 790510 | 05 | AZ | MEDICAID |