Healthcare Provider Details

I. General information

NPI: 1437313723
Provider Name (Legal Business Name): NARENDRA SANKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 12/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 S HIGHWAY 69 SUITE 102
DEWEY AZ
86327-7082
US

IV. Provider business mailing address

PO BOX 1568
DEWEY AZ
86327-1568
US

V. Phone/Fax

Practice location:
  • Phone: 928-632-5291
  • Fax: 928-632-5447
Mailing address:
  • Phone: 928-632-5291
  • Fax: 928-632-5447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number45041
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: