Provider Demographics
NPI:1821275231
Name:GENDY, GEORGE T (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:T
Last Name:GENDY
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 1:6320 W UNION HILLS DR STE 1800
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1372
Mailing Address - Country:US
Mailing Address - Phone:480-420-0749
Mailing Address - Fax:480-420-0732
Practice Address - Street 1:19636 N 27TH AVE
Practice Address - Street 2:STE 401
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027
Practice Address - Country:US
Practice Address - Phone:602-298-8888
Practice Address - Fax:602-978-4129
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49481174400000X, 207X00000X, 207XX0004X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPENDINGMedicaid
AZPENDINGMedicaid