Healthcare Provider Details

I. General information

NPI: 1174581581
Provider Name (Legal Business Name): JOANNE B GURIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 E FLOWER ST
PHOENIX AZ
85014-5698
US

IV. Provider business mailing address

PO BOX 82154
PHOENIX AZ
85071-2154
US

V. Phone/Fax

Practice location:
  • Phone: 602-301-0863
  • Fax:
Mailing address:
  • Phone: 602-301-0863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number14114
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: