Provider Demographics
NPI:1326235391
Name:GILBERT FAMILY MEDICINE KEITH
Entity Type:Organization
Organization Name:GILBERT FAMILY MEDICINE KEITH
Other - Org Name:GILBERT FAMILY MED KEITH
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:GINSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-355-8180
Mailing Address - Street 1:3011 S LINDSAY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-4334
Mailing Address - Country:US
Mailing Address - Phone:480-355-8180
Mailing Address - Fax:480-355-8844
Practice Address - Street 1:3011 S LINDSAY RD STE 110
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-4334
Practice Address - Country:US
Practice Address - Phone:480-355-8180
Practice Address - Fax:480-355-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H19359Medicare UPIN
Z101778Medicare PIN