Provider Demographics
NPI:1750492757
Name:UROLOGIC CONSULTANTS PC
Entity Type:Organization
Organization Name:UROLOGIC CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-539-8300
Mailing Address - Street 1:PO BOX 11450
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-0025
Mailing Address - Country:US
Mailing Address - Phone:480-539-8300
Mailing Address - Fax:
Practice Address - Street 1:2450 E GUADALUPE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5116
Practice Address - Country:US
Practice Address - Phone:480-539-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ62844Medicare PIN