Provider Demographics
NPI:1801817598
Name:GORTNER, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:GORTNER
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 1:1891 W ORANGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1116
Mailing Address - Country:US
Mailing Address - Phone:520-694-8900
Mailing Address - Fax:520-694-0113
Practice Address - Street 1:1891 W ORANGE GROVE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1116
Practice Address - Country:US
Practice Address - Phone:520-694-8900
Practice Address - Fax:520-694-0113
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ44295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA110170999OtherRAILROAD MEDICARE
WAG455OtherBLUE SHIELD
WAMD434WAOtherALASKA MEDICAID
WAUS0899780OtherAETNA/USHC SPECIALIST
WA0039581OtherLABOR & INDUSTRY
WA8263105Medicaid
WAG455OtherBLUE SHIELD
WA110170999OtherRAILROAD MEDICARE
WA001267042Medicare PIN
WA115113441Medicare PIN