Healthcare Provider Details

I. General information

NPI: 1639341795
Provider Name (Legal Business Name): GENEVIE LOREE KOCOUREK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GENEVIE LOREE SHARP

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 E GREENWAY PKWY # 103-449
SCOTTSDALE AZ
85254-2025
US

IV. Provider business mailing address

27925 N WALNUT CREEK RD
RIO VERDE AZ
85263-5243
US

V. Phone/Fax

Practice location:
  • Phone: 480-714-5692
  • Fax: 888-372-3577
Mailing address:
  • Phone: 480-714-5692
  • Fax: 888-372-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCDR.0000875
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20336
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11961125-1205
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number62177
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53754
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: