Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 20643 | WI |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 53242 | AZ |
NPI | 1093736209 |
---|---|
Provider Name | Jordan A. Sennett |
First Address | Glendale, AZ 85306-3722 |
Second Address | Glendale, AZ 85306-3722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 13/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093736209 | (05) | MI |
30225900 | (05) | WI |
B85243 | (02) | WI |