Individual
ROD E GENCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
680 E DEUCE OF CLUBS, SHOW LOW, AZ 85901-4829
(480) 682-4118
(480) 682-4101
Mailing address
15223 N 87TH ST, #110, SCOTTSDALE, AZ 85260-2639
(480) 682-4100
(480) 682-4101
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1963
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
442294
—
AZ
Enumeration date
08/20/2006
Last updated
03/31/2016
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