Healthcare Provider Details

I. General information

NPI: 1780651737
Provider Name (Legal Business Name): PIERRE CLAUDE GILLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4524 N MARYVALE PKWY SUITE 220
PHOENIX AZ
85031-1730
US

IV. Provider business mailing address

5880 S HOSPITAL DR
GLOBE AZ
85501-9447
US

V. Phone/Fax

Practice location:
  • Phone: 623-535-4582
  • Fax: 623-848-4399
Mailing address:
  • Phone: 928-402-1131
  • Fax: 928-425-7903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11263
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036058048
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: