Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 44352 | AZ |
NPI | 1003040940 |
---|---|
Provider Name | Christopher K Jentoft |
First Address | Wickenburg, AZ 85390-1447 |
Second Address | Whiteriver, AZ 85941-0860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2009 |
Last Update Date | 11/02/2016 |