Healthcare Provider Details

I. General information

NPI: 1073309571
Provider Name (Legal Business Name): EAST VALLEY MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 S VAL VISTA DR STE 105
GILBERT AZ
85296-3139
US

IV. Provider business mailing address

754 S VAL VISTA DR STE 105
GILBERT AZ
85296-3139
US

V. Phone/Fax

Practice location:
  • Phone: 480-497-2900
  • Fax: 480-497-2906
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. GREG J VOGEL
Title or Position: OWNER/MANAGER
Credential: DC
Phone: 480-497-2900