Provider Demographics
NPI:1326025792
Name:PASS, GERALD EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:EDWARD
Last Name:PASS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1950 W FRYE RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6255
Mailing Address - Country:US
Mailing Address - Phone:480-895-9555
Mailing Address - Fax:480-802-7845
Practice Address - Street 1:1187 E COTTONWOOD LN
Practice Address - Street 2:SUITE B
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-2957
Practice Address - Country:US
Practice Address - Phone:520-836-1000
Practice Address - Fax:520-836-6515
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2974207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0019597601Medicaid
AZ118996Medicare PIN
AZ0019597601Medicaid