Provider Demographics
NPI:1730152422
Name:JAIN, PANKAJ M (MD)
Entity type:Individual
Prefix:
First Name:PANKAJ
Middle Name:M
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:13555 W MCDOWELL RD STE 302
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2629
Mailing Address - Country:US
Mailing Address - Phone:623-512-4390
Mailing Address - Fax:623-512-4139
Practice Address - Street 1:13555 W MCDOWELL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2624
Practice Address - Country:US
Practice Address - Phone:623-512-4390
Practice Address - Fax:623-512-4391
Is Sole Proprietor?:No
Enumeration Date:2006-02-11
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ32772208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7346552OtherAETNA
AZ869117Medicaid
AZ11266362OtherCAQH
AZAZ0760380OtherBLUE CROSS BLUE SHIELD
AZ7755462OtherCIGNA
AZZ108700Medicare PIN
AZ869117Medicaid