Active NPI
Jeffery Carleton Northup, DO
- Specialist
- Show Low, AZ
National Provider Identifier
1760595342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1447
- Practice address
- 5171 Cub Lake Road
BLDG B Suite 210
Show Low, AZ 85901 - Phone
- (800) 344-8299
- Fax
- (928) 537-4437
- NPI assigned
- Aug 16, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1447 | AZ | Primary |
Addresses
Primary practice location
5171 Cub Lake Road
BLDG B Suite 210
Show Low, AZ 85901
Mailing address
5171 Cub Lake Road
BLDG B Suite 210
Show Low, AZ 85901
Phone (800) 344-8299
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 227654-02 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760595342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5171 CUB LAKE ROAD",
"address_2": "BLDG B SUITE 210",
"city": "SHOW LOW",
"state": "AZ",
"postal_code": "85901",
"telephone_number": "800-344-8299",
"fax_number": "928-537-4437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5171 CUB LAKE ROAD",
"address_2": "BLDG B SUITE 210",
"city": "SHOW LOW",
"state": "AZ",
"postal_code": "85901",
"telephone_number": "800-344-8299",
"fax_number": "928-537-4437"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NORTHUP",
"first_name": "JEFFERY",
"middle_name": "CARLETON",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AZ",
"license": "1447",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "227654-02",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Show Low, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.