Individual
DR. ETHAN OWEN KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
10240 W INDIAN SCHOOL RD STE 155, PHOENIX, AZ 85037-5909
(623) 385-7900
(623) 440-4360
Mailing address
10240 W INDIAN SCHOOL RD STE 155, PHOENIX, AZ 85037-5909
(623) 385-7900
(623) 440-4360
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3123
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
452673
—
AZ
Enumeration date
11/28/2006
Last updated
12/20/2023
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