Provider Demographics
NPI:1407811276
Name:KENTRO, TENNEY BRAND (MD)
Entity Type:Individual
Prefix:DR
First Name:TENNEY
Middle Name:BRAND
Last Name:KENTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6336 N ORACLE RD # 326-344
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5480
Mailing Address - Country:US
Mailing Address - Phone:520-297-1803
Mailing Address - Fax:520-268-8266
Practice Address - Street 1:7030 N STARDUST CIR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-1134
Practice Address - Country:US
Practice Address - Phone:520-297-1803
Practice Address - Fax:520-268-8266
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25062207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0803530OtherBC/BS OF ARIZONA
AZ404054OtherAHCCCS
AZ110145525OtherRAILROAD MEDICARE
AZZMD25062Medicare ID - Type UnspecifiedMEDICARE