Provider Demographics
NPI:1851340467
Name:GAMOTH, JAYSHRI (MD)
Entity Type:Individual
Prefix:MS
First Name:JAYSHRI
Middle Name:
Last Name:GAMOTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 E BASELINE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4616
Mailing Address - Country:US
Mailing Address - Phone:480-982-3337
Mailing Address - Fax:480-497-4580
Practice Address - Street 1:4540 E BASELINE RD STE 109
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4616
Practice Address - Country:US
Practice Address - Phone:480-982-3337
Practice Address - Fax:480-497-4580
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36353207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDN5890OtherRAIL ROAD MEDICARE
AZZ121107Medicare PIN