Healthcare Provider Details

I. General information

NPI: 1881698264
Provider Name (Legal Business Name): MARK D GULINSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST STE 4035
PHOENIX AZ
85020-2434
US

IV. Provider business mailing address

3020 E CAMELBACK RD SUITE 301
PHOENIX AZ
85016-5095
US

V. Phone/Fax

Practice location:
  • Phone: 623-279-3575
  • Fax: 602-279-2666
Mailing address:
  • Phone: 602-264-9100
  • Fax: 602-264-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number24155
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number24155
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: