Provider Demographics
NPI:1518959527
Name:BETZ, GARY A (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:BETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39179
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-9179
Mailing Address - Country:US
Mailing Address - Phone:602-395-0718
Mailing Address - Fax:602-277-8146
Practice Address - Street 1:7010 E CHAUNCEY LN
Practice Address - Street 2:STE 145
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-3111
Practice Address - Country:US
Practice Address - Phone:480-502-5533
Practice Address - Fax:480-502-5761
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2Z2576OtherHEALTH NET
AZ872483OtherAHCCCS
AZAZ0785250OtherBLUE CROSS BLUE SHIELD
AZ872483Medicaid
AZ7944569OtherAETNA
AZ2Z2576OtherHEALTH NET
AZ872483OtherAHCCCS