Provider Demographics
NPI:1275764854
Name:GERGES, AMIR EZZAT (DO)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:EZZAT
Last Name:GERGES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2149 E WARNER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3494
Mailing Address - Country:US
Mailing Address - Phone:480-610-6100
Mailing Address - Fax:480-610-6189
Practice Address - Street 1:1000 WILLOW CREEK RD
Practice Address - Street 2:SUITE F
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1645
Practice Address - Country:US
Practice Address - Phone:480-610-6100
Practice Address - Fax:480-610-6189
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ006747207RN0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ038696Medicaid
AZZ178696Medicare PIN