Healthcare Provider Details

I. General information

NPI: 1831170570
Provider Name (Legal Business Name): GERARDO CARLOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13395 N MARANA MAIN ST
MARANA AZ
85653-7008
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-682-4111
  • Fax: 520-682-3817
Mailing address:
  • Phone: 520-682-4111
  • Fax: 520-682-3817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number15877
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: