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Contact Information

JEFFERY C NORTHUP, DO
5171 CUB LAKE ROAD
BLDG B SUITE 210
SHOW LOW, AZ85901
 Phone: 800-344-8299
 Fax: 928-537-4437
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Specialist

174400000X
Indicates primary specialty

NPI Profile & details for JEFFERY C NORTHUP · (Male)

NPI Number 1760595342
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 08/16/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 Yes
Identifiers
  • AZ License # 1447
  • AZ Medicaid 227654-02
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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