Provider Demographics
NPI:1619900545
Name:O'DESKY, GERARD M (DO)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:M
Last Name:O'DESKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11646 E CAVEDALE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-8010
Mailing Address - Country:US
Mailing Address - Phone:480-515-1477
Mailing Address - Fax:480-515-1477
Practice Address - Street 1:11646 E CAVEDALE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-8010
Practice Address - Country:US
Practice Address - Phone:480-515-1477
Practice Address - Fax:480-515-1477
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101006101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E37598Medicare UPIN