Healthcare Provider Details

I. General information

NPI: 1295149896
Provider Name (Legal Business Name): WILLIAM PAUL HENNON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 02/13/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19420 N 59TH AVE STE H800
GLENDALE AZ
85308-6977
US

IV. Provider business mailing address

19420 N 59TH AVE STE H800
GLENDALE AZ
85308-6977
US

V. Phone/Fax

Practice location:
  • Phone: 602-889-7365
  • Fax: 602-993-1745
Mailing address:
  • Phone: 602-889-7365
  • Fax: 602-993-1745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL37116
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036142905
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: