Provider Demographics
NPI:1558591644
Name:GAZDA, RENEE M
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:GAZDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 W BETHANY HOME RD # 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2443
Mailing Address - Country:US
Mailing Address - Phone:602-246-5525
Mailing Address - Fax:602-433-6686
Practice Address - Street 1:2000 W BETHANY HOME RD # 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2443
Practice Address - Country:US
Practice Address - Phone:602-246-5525
Practice Address - Fax:602-433-6686
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine