Healthcare Provider Details

I. General information

NPI: 1639129919
Provider Name (Legal Business Name): RUSSELL SCOTT GILBERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8149 N 87TH PL SUITE 109
SCOTTSDALE AZ
85258-4399
US

IV. Provider business mailing address

8149 N 87TH PL SUITE 109
SCOTTSDALE AZ
85258-4399
US

V. Phone/Fax

Practice location:
  • Phone: 480-467-0300
  • Fax:
Mailing address:
  • Phone: 480-467-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number23296
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number23296
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: