1154178226 NPI number — DAVID A GEHRET MD- A PROFESSIONAL CORPORATION

Table of content: (NPI 1154178226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154178226 NPI number — DAVID A GEHRET MD- A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID A GEHRET MD- A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154178226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6499 S KINGS RANCH RD STE 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLD CANYON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85118-2920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-873-6610
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
366 SAN MIGUEL DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92660-7810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-873-6610
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/06/2024

Additional Information

Authorized Official

Authorized Official Last Name:
GEHRET
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
949-873-6610

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com