Healthcare Provider Details

I. General information

NPI: 1417227331
Provider Name (Legal Business Name): WILLIAM ROLLIN GERCHICK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6302 E HILLVIEW ST
MESA AZ
85205-4543
US

IV. Provider business mailing address

6302 E HILLVIEW ST
MESA AZ
85205-4543
US

V. Phone/Fax

Practice location:
  • Phone: 480-832-4354
  • Fax: 480-832-3854
Mailing address:
  • Phone: 480-832-4354
  • Fax: 480-832-3854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1025
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number1025
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: