Healthcare Provider Details

I. General information

NPI: 1215007885
Provider Name (Legal Business Name): GERALD MOCZYNSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 01/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6036 N 19TH AVE SUITE 206
PHOENIX AZ
85015-2104
US

IV. Provider business mailing address

6036 N 19TH AVE SUITE 206
PHOENIX AZ
85015-2104
US

V. Phone/Fax

Practice location:
  • Phone: 602-242-6248
  • Fax: 602-242-6264
Mailing address:
  • Phone: 602-242-6248
  • Fax: 602-242-6264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberAZ9173
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: