Basic Information
| Provider Information | |||||||||
| NPI: | 1467406090 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JEANTY | ||||||||
| FirstName: | ADRIAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 444 N 44TH ST | ||||||||
| Address2: | #400 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850087624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026853846 | ||||||||
| FaxNumber: | 6026853808 | ||||||||
| Practice Location | |||||||||
| Address1: | 3450 N HIGLEY RD | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852159702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809817735 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 32946 | AZ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 474023 | 05 | AZ | MEDICAID |