Provider Demographics
NPI:1316019946
Name:KENNY, JEFFREY AARON (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:AARON
Last Name:KENNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3330 N 2ND ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2368
Mailing Address - Country:US
Mailing Address - Phone:602-261-7830
Mailing Address - Fax:602-261-7835
Practice Address - Street 1:3330 N 2ND ST
Practice Address - Street 2:SUITE300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2368
Practice Address - Country:US
Practice Address - Phone:602-274-7195
Practice Address - Fax:602-274-7097
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ42594207RP1001X, 207RC0200X
WI463207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ522339Medicaid