Provider Demographics
NPI:1750330056
Name:AMES, GREGORY G (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:G
Last Name:AMES
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 1:5301 S SUPERSTITION MOUNTAIN DR
Mailing Address - Street 2:SUITE 104-476
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85218-1919
Mailing Address - Country:US
Mailing Address - Phone:480-288-9250
Mailing Address - Fax:
Practice Address - Street 1:5301 S SUPERSTITION MOUNTAIN DR
Practice Address - Street 2:SUITE 104-476
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85218-1919
Practice Address - Country:US
Practice Address - Phone:480-288-9250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2004-0605207P00000X
AZ33416207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM85379051Medicaid
NME94173Medicare UPIN