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General NPI Number Information
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NPI Number | 1568535714
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Entity Type | Organization
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Legal Business Name | GARY KERSTEN MD PC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 09/19/2008
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Provider Practice Location Address
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Address Line | 1715 W NORTHERN AVE 108
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City | PHOENIX
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State | AZ
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Zip | 85021-5472
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Country | US
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Telephone | 602-395-0718
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Fax | 602-277-8146
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Provider Business Mailing Address
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Address Line | 1715 W NORTHERN AVE 108
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City | PHOENIX
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State | AZ
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Zip | 85021-5472
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Country | US
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Telephone | 602-395-0718
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Fax | 602-277-8146
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Authorized Official
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Title or Position | OBGYN
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Name | GARY KERSTEN
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Credential | MD
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Telephone | 602-395-0718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | AZ
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