Provider Demographics
NPI:1417227331
Name:GERCHICK, WILLIAM ROLLIN (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROLLIN
Last Name:GERCHICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 E HILLVIEW ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4543
Mailing Address - Country:US
Mailing Address - Phone:480-832-4354
Mailing Address - Fax:480-832-3854
Practice Address - Street 1:6302 E HILLVIEW ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4543
Practice Address - Country:US
Practice Address - Phone:480-832-4354
Practice Address - Fax:480-832-3854
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1025207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine