Provider Demographics
NPI:1477517423
Name:GARY BETZ II MD PC
Entity Type:Organization
Organization Name:GARY BETZ II MD PC
Other - Org Name:THOMPSON PEAK INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-502-5533
Mailing Address - Street 1:7010 E. CHAUNCEY LANE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054
Mailing Address - Country:US
Mailing Address - Phone:480-502-5533
Mailing Address - Fax:480-502-5761
Practice Address - Street 1:7010 E. CHAUNCEY LANE
Practice Address - Street 2:SUITE 145
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054
Practice Address - Country:US
Practice Address - Phone:480-502-5533
Practice Address - Fax:480-502-5761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ104895Medicare PIN