Provider Demographics
NPI:1316003338
Name:SOLLENBERGER, JOHN GEOFFREY (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GEOFFREY
Last Name:SOLLENBERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 W MONROE ST
Mailing Address - Street 2:#1907
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-4553
Mailing Address - Country:US
Mailing Address - Phone:630-939-0772
Mailing Address - Fax:
Practice Address - Street 1:44 W MONROE ST
Practice Address - Street 2:#1907
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-4553
Practice Address - Country:US
Practice Address - Phone:630-939-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005711208100000X
WAOP601419092081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ621467Medicaid