Healthcare Provider Details

I. General information

NPI: 1639406853
Provider Name (Legal Business Name): MELISSA ANN GEBHARDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 S DOBSON RD SUITE 201
MESA AZ
85202-4768
US

IV. Provider business mailing address

1432 S DOBSON RD SUITE 201
MESA AZ
85202-4768
US

V. Phone/Fax

Practice location:
  • Phone: 480-962-0071
  • Fax: 480-962-0590
Mailing address:
  • Phone: 480-962-0071
  • Fax: 480-962-0590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4546
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number4546
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: