Individual
JEFFREY M SANWICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
811 AINSWORTH DR, SUITE 101, PRESCOTT, AZ 86301-1687
(928) 771-5282
(928) 771-5283
Mailing address
811 AINSWORTH DR, STE 101, PRESCOTT, AZ 86301-1687
(928) 771-5282
(928) 771-5283
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
24728
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
340017265
RAILROAD MEDICARE
AZ
05
—
482167
—
AZ
01
—
AZ0855380
BLUE CROSS/BLUE SHIELD
AZ
Enumeration date
06/29/2006
Last updated
07/26/2019
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