1588777387 NPI number — DR. MARK J GENTILE MD

Table of content: DR. MARK J GENTILE MD (NPI 1588777387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588777387 NPI number — DR. MARK J GENTILE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GENTILE
Provider First Name:
MARK
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1588777387
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2680 S VAL VISTA DR
Provider Second Line Business Mailing Address:
STE 167
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85295-1638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-857-0222
Provider Business Mailing Address Fax Number:
480-857-0020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2680 S VAL VISTA DR
Provider Second Line Business Practice Location Address:
STE 167
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85295-1638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-857-0222
Provider Business Practice Location Address Fax Number:
480-857-0020
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  AZ12913 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 25172803 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com