MEDICARE: MS. JAYSHRI GAMOTH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	36353	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DN5890	OTHER	AZ	RAIL ROAD MEDICARE

General Provider Information

NPI Number	:	1851340467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAYSHRI GAMOTH MD

Provider Business Mailing Address
First Line	:	4540 E BASELINE RD STE 109
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4616
Country	:	US
Telephone Number	:	480-982-3337
Fax Number	:	480-497-4580

Provider Business Practice Location Address
First Line	:	4540 E BASELINE RD STE 109
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4616
Country	:	US
Telephone Number	:	480-982-3337
Fax Number	:	480-497-4580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	09/25/2023

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