Healthcare Provider Details

I. General information

NPI: 1073550828
Provider Name (Legal Business Name): GAYLA WIGAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7725 N 43RD AVE 510
PHOENIX AZ
85051-5770
US

IV. Provider business mailing address

9520 W PALM LN SUITE 200
PHOENIX AZ
85037-4403
US

V. Phone/Fax

Practice location:
  • Phone: 877-809-5092
  • Fax: 623-815-9253
Mailing address:
  • Phone: 877-809-5092
  • Fax: 623-815-9253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15306
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: