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General NPI Number Information
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NPI Number | 1073309571
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Entity Type | Organization
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Legal Business Name | EAST VALLEY MEDICAL LLC
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Dates
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Enumeration Date | 04/19/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 754 S VAL VISTA DR STE 105
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City | GILBERT
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State | AZ
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Zip | 85296-3139
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Country | US
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Telephone | 480-497-2900
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Fax | 480-497-2906
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Provider Business Mailing Address
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Address Line | 754 S VAL VISTA DR STE 105
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City | GILBERT
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State | AZ
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Zip | 85296-3139
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. GREG J VOGEL
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Credential | DC
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Telephone | 480-497-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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