MEDICARE: MR. PATRICK JOHN ENKING MS, PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1447649710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK JOHN ENKING MS, PA-C

Provider Business Mailing Address
First Line	:	435 N 5TH ST
Second Line	:	NAU PA PROGRAM HSEB C615
City	:	PHOENIX
State	:	AZ
Zip	:	85004-2157
Country	:	US
Telephone Number	:	602-827-2415
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 N 5TH ST
Second Line	:	NAU PA PROGRAM HSEB C615
City	:	PHOENIX
State	:	AZ
Zip	:	85004-2157
Country	:	US
Telephone Number	:	602-827-2415
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2015
Last Update Date	:	01/09/2015

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