Provider Demographics
NPI:1598703977
Name:SERNA, JOE REN'E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:REN'E
Last Name:SERNA
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:PO BOX 782
Mailing Address - Street 2:3740 LOMITA
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86402-0782
Mailing Address - Country:US
Mailing Address - Phone:928-692-1634
Mailing Address - Fax:
Practice Address - Street 1:1510 STOCKTON HILL RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-5173
Practice Address - Country:US
Practice Address - Phone:928-753-1177
Practice Address - Fax:928-753-1178
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16279208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics