MEDICARE: GARY A ERBSTOESSER DO

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	207Q00000X	Family Medicine Physician	2751	AZ
2	207QS0010X	Sports Medicine (Family Medicine) Physician	2751	AZ
3	207QS0010X	Sports Medicine (Family Medicine) Physician	02751	AZ
4	207Q00000X	Family Medicine Physician	02751	AZ

General Provider Information

NPI Number	:	1871692574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY A ERBSTOESSER DO

Provider Business Mailing Address
First Line	:	3805 E BELL ROAD
Second Line	:	ST. 5300
City	:	PHOENIX
State	:	AZ
Zip	:	85032
Country	:	US
Telephone Number	:	602-246-0351
Fax Number	:	602-246-7023

Provider Business Practice Location Address
First Line	:	3805 E BELL ROAD
Second Line	:	ST. 5300
City	:	PHOENIX
State	:	AZ
Zip	:	85032
Country	:	US
Telephone Number	:	602-246-0351
Fax Number	:	602-246-7023

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	05/17/2019

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