Provider Demographics
NPI:1437713286
Name:LENAHAN, JOHN DAGGETT (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAGGETT
Last Name:LENAHAN
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 1:8088 W WHITNEY DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6564
Mailing Address - Country:US
Mailing Address - Phone:602-344-5287
Mailing Address - Fax:
Practice Address - Street 1:2025 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5157
Practice Address - Country:US
Practice Address - Phone:833-855-9973
Practice Address - Fax:602-655-9630
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME152434207Q00000X
VI3392207Q00000X, 207Q00000X
AZ67504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine