Healthcare Provider Details

I. General information

NPI: 1427029081
Provider Name (Legal Business Name): GARY R FRATESI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7922 E COCHISE RD
SCOTTSDALE AZ
85258-1208
US

IV. Provider business mailing address

7922 E COCHISE RD
SCOTTSDALE AZ
85258-1208
US

V. Phone/Fax

Practice location:
  • Phone: 480-421-8169
  • Fax:
Mailing address:
  • Phone: 480-421-8169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number37975
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: