Provider Demographics
NPI:1285696351
Name:SCHENNE, ALAN J (DO)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:SCHENNE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10080
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-759-5987
Mailing Address - Fax:928-458-2039
Practice Address - Street 1:1050 GAIL GARDNER WAY STE 300
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1640
Practice Address - Country:US
Practice Address - Phone:928-717-5232
Practice Address - Fax:928-717-5238
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA3654207Q00000X
AZ007190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ007190OtherARIZONA LICENSE
AZ260247Medicaid
AZZ202481OtherMEDICARE
AZ007190OtherARIZONA LICENSE
IA02487OtherWELLMARK BCBS IA
IA7716580Medicaid
IAI16216Medicare PIN
IA0476812Medicaid