Healthcare Provider Details

I. General information

NPI: 1972586006
Provider Name (Legal Business Name): JOSEPH A. GASSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5131 E SOUTHERN AVE
MESA AZ
85206-2799
US

IV. Provider business mailing address

1919 E THOMAS RD BLDG 2108 101
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 480-833-5437
  • Fax: 480-833-9349
Mailing address:
  • Phone: 602-512-8029
  • Fax: 602-512-8161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18975
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number18975
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47682
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: