Provider Demographics
NPI:1841908035
Name:SENEGAL, COREY ALEXANDER (PA)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:ALEXANDER
Last Name:SENEGAL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 S HAMPTON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-2363
Mailing Address - Country:US
Mailing Address - Phone:214-330-9921
Mailing Address - Fax:
Practice Address - Street 1:10815 W MCDOWELL RD STE 304
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5016
Practice Address - Country:US
Practice Address - Phone:623-433-0155
Practice Address - Fax:623-433-0185
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16388363A00000X
AZ10632363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant