Individual
SCOTT R DERENNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C (PHYSICIAN ASSI
Contact information
Practice address
15225 S 15TH AVE, PHOENIX, AZ 85045-1904
(920) 737-4014
(920) 288-8355
Mailing address
15225 S 15TH AVE, PHOENIX, AZ 85045-1904
(920) 737-4014
(920) 288-8355
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
913
WI
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/12/2006
Last updated
07/10/2019
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