Healthcare Provider Details

I. General information

NPI: 1891816625
Provider Name (Legal Business Name): ERDAL M GURGOZE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 W BETHANY HOME RD # E100
PHOENIX AZ
85015-2458
US

IV. Provider business mailing address

300 W CLARENDON AVE STE 350
PHOENIX AZ
85013-3497
US

V. Phone/Fax

Practice location:
  • Phone: 602-274-4484
  • Fax: 602-287-9406
Mailing address:
  • Phone: 602-274-4484
  • Fax: 602-287-9406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: