Healthcare Provider Details

I. General information

NPI: 1669738142
Provider Name (Legal Business Name): GILBERT MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 S VAL VISTA DR STE105
GILBERT AZ
85296-3157
US

IV. Provider business mailing address

754 S.VAL VISTA DR. STE105
GILBERT AZ
85296
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. GREG VOGEL
Title or Position: CEO
Credential:
Phone: 480-497-2900