Healthcare Provider Details

I. General information

NPI: 1093278731
Provider Name (Legal Business Name): GAURAV AGGARWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date: 10/31/2019
Reactivation Date: 11/18/2019

III. Provider practice location address

500 W THOMAS RD STE 870
PHOENIX AZ
85013-4218
US

IV. Provider business mailing address

3033 N CENTRAL AVE STE 145
PHOENIX AZ
85012-2808
US

V. Phone/Fax

Practice location:
  • Phone: 480-964-2273
  • Fax:
Mailing address:
  • Phone: 623-583-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number65653
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: