Healthcare Provider Details

I. General information

NPI: 1659363513
Provider Name (Legal Business Name): ROBERT LEE GEAR III D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 N 7TH ST
PHOENIX AZ
85014-5204
US

IV. Provider business mailing address

3543 N 7TH ST
PHOENIX AZ
85014-5204
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-8484
  • Fax: 602-263-3697
Mailing address:
  • Phone: 602-263-8484
  • Fax: 602-263-3697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number3202
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number3202
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number3202
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: