Provider Demographics
NPI:1740223114
Name:BEREBITSKY, GARY LEE (MD)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:BEREBITSKY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:10750 W MCDOWELL RD
Mailing Address - Street 2:G700
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5960
Mailing Address - Country:US
Mailing Address - Phone:623-873-0321
Mailing Address - Fax:623-849-9623
Practice Address - Street 1:10750 W MCDOWELL RD
Practice Address - Street 2:G700
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392
Practice Address - Country:US
Practice Address - Phone:623-873-0321
Practice Address - Fax:623-849-9623
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-05-27
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Provider Licenses
StateLicense IDTaxonomies
AZ16877208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ268773Medicaid