Provider Demographics
NPI:1831119627
Name:DONESKEY, GORDON TRENT (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:TRENT
Last Name:DONESKEY
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 1:2730 S VAL VISTA DR
Mailing Address - Street 2:STE 187
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1684
Mailing Address - Country:US
Mailing Address - Phone:480-324-0300
Mailing Address - Fax:480-324-0324
Practice Address - Street 1:2730 S VAL VISTA DR
Practice Address - Street 2:SUITE 187
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-6675
Practice Address - Country:US
Practice Address - Phone:480-324-0300
Practice Address - Fax:480-324-0324
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZC99378Medicare UPIN
AZ63822Medicare ID - Type Unspecified