Basic Information
Provider Information | |||||||||
NPI: | 1922074012 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LABOWITZ | ||||||||
FirstName: | JODIE | ||||||||
MiddleName: | K | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ABRAMS | ||||||||
OtherFirstName: | JODIE | ||||||||
OtherMiddleName: | K | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: | VIII | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 3020 NE CAMELBACK RD | ||||||||
Address2: | SUITE 301 | ||||||||
City: | PHOENIX | ||||||||
State: | AZ | ||||||||
PostalCode: | 850165095 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6022649100 | ||||||||
FaxNumber: | 6022649101 | ||||||||
Practice Location | |||||||||
Address1: | 5823 W EUGIE AVE | ||||||||
Address2: | STE A | ||||||||
City: | GLENDALE | ||||||||
State: | AZ | ||||||||
PostalCode: | 853041276 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6028431265 | ||||||||
FaxNumber: | 6028431297 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/27/2006 | ||||||||
LastUpdateDate: | 02/16/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 26966 | AZ | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
ID | Type | State | Issuer | Description | 120390 | 01 | AZ | GROUP MEDICARE NUMBER | OTHER | 317047 | 01 | AZ | GROUP MEDICAID NUMBER | OTHER | 439621 01 | 05 | AZ |   | MEDICAID |