Healthcare Provider Details

I. General information

NPI: 1811966856
Provider Name (Legal Business Name): CLIFFORD J. GUSS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 W THUNDERBIRD RD STE A100
GLENDALE AZ
85306-4661
US

IV. Provider business mailing address

5750 W THUNDERBIRD RD STE A100
GLENDALE AZ
85306-4661
US

V. Phone/Fax

Practice location:
  • Phone: 602-938-3205
  • Fax: 602-938-5799
Mailing address:
  • Phone: 602-938-3205
  • Fax: 602-938-5799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2984
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: