Healthcare Provider Details

I. General information

NPI: 1679741409
Provider Name (Legal Business Name): SCOTT M GULINSON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 W THUNDERBIRD RD STE 308
GLENDALE AZ
85306-4710
US

IV. Provider business mailing address

5310 W THUNDERBIRD RD STE 308
GLENDALE AZ
85306-4710
US

V. Phone/Fax

Practice location:
  • Phone: 623-412-2229
  • Fax:
Mailing address:
  • Phone: 623-412-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number27414
License Number StateAZ

VIII. Authorized Official

Name: SCOTT M GULINSON
Title or Position: OWNER
Credential: MD
Phone: 623-412-2229