Healthcare Provider Details

I. General information

NPI: 1255322871
Provider Name (Legal Business Name): ROBERT GARY GAGLIANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S CANDY LN SUITE 9A
COTTONWOOD AZ
86326-4120
US

IV. Provider business mailing address

203 S CANDY LN SUITE 9A
COTTONWOOD AZ
86326-4120
US

V. Phone/Fax

Practice location:
  • Phone: 928-639-6299
  • Fax: 928-639-6292
Mailing address:
  • Phone: 928-639-6299
  • Fax: 928-639-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number25096
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: