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General NPI Number Information
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NPI Number | 1437447554
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Entity Type | Individual
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Provider Name | SHASHANK GARG M.D., M.B.B.S.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2011
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 9059 W LAKE PLEASANT PKWY STE C320
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City | PEORIA
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State | AZ
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Zip | 85382-8394
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Country | US
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Telephone | 623-300-9011
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Fax | 480-882-5821
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Provider Business Mailing Address
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Address Line | 9059 W LAKE PLEASANT PKWY STE C320
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City | PEORIA
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State | AZ
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Zip | 85382-8394
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Country | US
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Telephone | 623-300-9011
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Fax | 480-882-5821
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | DR.0073956
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | E-10304
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License Number State | AR
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