Provider Demographics
NPI:1831177864
Name:CARNES, JEAN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARIE
Last Name:CARNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JEAN
Other - Middle Name:MARIE
Other - Last Name:BERGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2251 N 32ND ST
Mailing Address - Street 2:LOT #31
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-2446
Mailing Address - Country:US
Mailing Address - Phone:480-641-7453
Mailing Address - Fax:480-641-7453
Practice Address - Street 1:2000 W BETHANY HOME RD
Practice Address - Street 2:PHOENIX BAPTIST HOSPITAL
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015
Practice Address - Country:US
Practice Address - Phone:602-249-0212
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06514207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ292912Medicaid
AZAZ0728670OtherBCBS - GROUP #
AZ3981220OtherEVERCARE - GROUP #
AZAW1436OtherHEALTHNET - GROUP #
E47747Medicare UPIN
AZAZ0728670OtherBCBS - GROUP #