Healthcare Provider Details

I. General information

NPI: 1093736209
Provider Name (Legal Business Name): JORDAN A. SENNETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6677 W THUNDERBIRD RD STE E
GLENDALE AZ
85306-3722
US

IV. Provider business mailing address

6677 W THUNDERBIRD RD STE E
GLENDALE AZ
85306-3722
US

V. Phone/Fax

Practice location:
  • Phone: 623-815-7800
  • Fax: 623-815-7900
Mailing address:
  • Phone: 623-815-7800
  • Fax: 623-815-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number20643
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number53242
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: