Provider Demographics
NPI:1265490783
Name:GAMEZ, ALBERT JESUS JR (MSN)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:JESUS
Last Name:GAMEZ
Suffix:JR
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6340 S RURAL RD
Mailing Address - Street 2:#118-209
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2932
Mailing Address - Country:US
Mailing Address - Phone:602-663-4057
Mailing Address - Fax:602-462-1186
Practice Address - Street 1:2025 N 3RD ST
Practice Address - Street 2:SUITE 170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1471
Practice Address - Country:US
Practice Address - Phone:602-794-2678
Practice Address - Fax:602-462-1186
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP2059363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9631805Medicaid
WA9631805Medicaid
WAP40455Medicare UPIN