Provider Demographics
NPI:1619078029
Name:KOHRING, GARY CLARENCE (D O)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:CLARENCE
Last Name:KOHRING
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2034 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4024
Mailing Address - Country:US
Mailing Address - Phone:480-831-0150
Mailing Address - Fax:480-831-0240
Practice Address - Street 1:2034 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4024
Practice Address - Country:US
Practice Address - Phone:480-831-0150
Practice Address - Fax:480-831-0240
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D47241Medicare UPIN