Provider Demographics
NPI:1285001172
Name:BARRY E GERSHWEIR MD PC
Entity Type:Organization
Organization Name:BARRY E GERSHWEIR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GERSHWEIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-886-4179
Mailing Address - Street 1:1500 N WILMOT RD
Mailing Address - Street 2:C 260
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4416
Mailing Address - Country:US
Mailing Address - Phone:520-886-4179
Mailing Address - Fax:
Practice Address - Street 1:1500 N WILMOT RD
Practice Address - Street 2:C 260
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4416
Practice Address - Country:US
Practice Address - Phone:520-886-4179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7348174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ230144Medicaid
AZC99530Medicare UPIN