Healthcare Provider Details

I. General information

NPI: 1114031119
Provider Name (Legal Business Name): EDWARD S GELARDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVE
TUCSON AZ
85724-0001
US

IV. Provider business mailing address

575 E RIVER RD
TUCSON AZ
85704-5822
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-7664
  • Fax: 520-626-4010
Mailing address:
  • Phone: 520-874-7400
  • Fax: 520-874-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4006
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: