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General NPI Number Information
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NPI Number | 1003821430
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Entity Type | Individual
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Provider Name | SANJEEV GOPAL MD
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 6424 E BROADWAY RD 104-105
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City | MESA
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State | AZ
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Zip | 85206-1750
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Country | US
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Telephone | 602-802-8700
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Fax | 602-802-8799
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Provider Business Mailing Address
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Address Line | 6424 E BROADWAY RD 104-105
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City | MESA
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State | AZ
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Zip | 85206-1750
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Country | US
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Telephone | 602-802-8700
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Fax | 602-802-8799
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 276077
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License Number State | NY
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