=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790781250
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRANKLYN R GERGITS III D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2005
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8573 E PRINCESS DR # B111
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-7819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-525-8999
-----------------------------------------------------
Fax | 480-999-4929
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9279 E MOUNTAIN SPRING RD
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-6608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-490-8819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | OS008222L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 007227
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------