Individual
COLAN ASHLEY KENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 N 12TH ST, #605, PHOENIX, AZ 85006-2848
(602) 239-4567
Mailing address
1300 N 12TH ST, #605, PHOENIX, AZ 85006-2848
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R71518
AZ
Other
Enumeration date
06/16/2009
Last updated
06/16/2009
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