Provider Demographics
NPI:1407955065
Name:GAUSE, WILLIAM B (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:GAUSE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:GAUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:6301 S MCCLINTOCK DR
Mailing Address - Street 2:#101
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3392
Mailing Address - Country:US
Mailing Address - Phone:480-214-2300
Mailing Address - Fax:480-214-2301
Practice Address - Street 1:2550 E GUADALUPE RD
Practice Address - Street 2:#115
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5114
Practice Address - Country:US
Practice Address - Phone:480-632-1544
Practice Address - Fax:480-632-1533
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2267363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical