Provider Demographics
NPI:1508844309
Name:HEMBRY, JOHN J (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:HEMBRY
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 1:21772 S ELLSWORTH LOOP RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-7709
Mailing Address - Country:US
Mailing Address - Phone:480-512-3700
Mailing Address - Fax:
Practice Address - Street 1:21772 S ELLSWORTH LOOP RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-7709
Practice Address - Country:US
Practice Address - Phone:480-512-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ009044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1508844309Medicaid
IA5296061Medicaid
IA6296061Medicaid
IAP00345237OtherRR MEDICARE
IA7296061Medicaid
IA4296061Medicaid
IAP00266823OtherRR MEDICARE
IA5296061Medicaid
IAI14965Medicare PIN