Provider Demographics
NPI:1760641559
Name:GERALD L YOSPUR MD PC
Entity Type:Organization
Organization Name:GERALD L YOSPUR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOSPUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-733-3933
Mailing Address - Street 1:1520 S DOBSON RD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4725
Mailing Address - Country:US
Mailing Address - Phone:480-733-3933
Mailing Address - Fax:480-733-3903
Practice Address - Street 1:1520 S DOBSON RD
Practice Address - Street 2:SUITE 213
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4725
Practice Address - Country:US
Practice Address - Phone:480-733-3933
Practice Address - Fax:480-733-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ263722086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty