Healthcare Provider Details

I. General information

NPI: 1225283260
Provider Name (Legal Business Name): ERGI O GUMUSANELI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E STATE HIGHWAY 260
PAYSON AZ
85541-4935
US

IV. Provider business mailing address

16810 AVENUE OF THE FOUNTAINS SUITE 200
FOUNTAIN HILLS AZ
85268
US

V. Phone/Fax

Practice location:
  • Phone: 303-808-5566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number48431
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA133155
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number49742
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number48431
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: