Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 005711 | AZ |
N | 2081S0010X | Sports Medicine | OP60141909 | WA |
N | 213ES0000X | Sports Medicine | OP60141909 | WA |
NPI | 1316003338 |
---|---|
Provider Name | John Geoffrey Sollenberger |
First Address | Phoenix, AZ 85003-4553 |
Second Address | Phoenix, AZ 85003-4553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 30/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
621467 | (05) | AZ |