Provider Demographics
NPI:1730242066
Name:FOUNTIS, SOPHIA J (DO)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:J
Last Name:FOUNTIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10725 E QUARTZ ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8134
Mailing Address - Country:US
Mailing Address - Phone:480-473-8985
Mailing Address - Fax:480-998-7093
Practice Address - Street 1:8660 E SHEA BLVD STE 9
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6654
Practice Address - Country:US
Practice Address - Phone:480-443-0778
Practice Address - Fax:480-998-7093
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2689207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDO2689Medicare ID - Type Unspecified
AZE61087Medicare UPIN