Provider Demographics
NPI:1376724955
Name:GERVAIS, ROBERT PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:GERVAIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 31270
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85275-1270
Mailing Address - Country:US
Mailing Address - Phone:602-568-8039
Mailing Address - Fax:480-835-7844
Practice Address - Street 1:1530 W GLENDALE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8578
Practice Address - Country:US
Practice Address - Phone:602-995-2000
Practice Address - Fax:602-995-8408
Is Sole Proprietor?:No
Enumeration Date:2007-11-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ8919207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ119938Medicare UPIN