Provider Demographics
NPI:1376954701
Name:KENLEIGH, DORIAN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:DORIAN
Middle Name:
Last Name:KENLEIGH
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N 12TH ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2849
Mailing Address - Country:US
Mailing Address - Phone:623-693-9675
Mailing Address - Fax:
Practice Address - Street 1:1300 N 12TH ST STE 520
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2849
Practice Address - Country:US
Practice Address - Phone:602-839-4456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ58925171100000X, 207PT0002X, 2083X0100X
IN01076045A171100000X, 207PT0002X, 2083X0100X, 208D00000X
CAC167244171100000X, 207PT0002X, 2083X0100X
WAMD61188901171100000X, 207PT0002X, 2083P0500X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171100000XOther Service ProvidersAcupuncturist
No207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical ToxicologyGroup - Multi-Specialty
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine