Healthcare Provider Details

I. General information

NPI: 1710824081
Provider Name (Legal Business Name): AZ MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 N 108TH AVE STE 142
PHOENIX AZ
85037-5467
US

IV. Provider business mailing address

4150 N 108TH AVE STE 142
PHOENIX AZ
85037-5467
US

V. Phone/Fax

Practice location:
  • Phone: 651-318-2025
  • Fax:
Mailing address:
  • Phone: 651-318-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: GERALD IRWIN
Title or Position: MD
Credential:
Phone: 651-318-2025