Provider Demographics
NPI:1942292628
Name:GOSSLER, KENNETH B (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:B
Last Name:GOSSLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4881 E GRANT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2704
Mailing Address - Country:US
Mailing Address - Phone:520-318-6035
Mailing Address - Fax:520-795-9953
Practice Address - Street 1:4582 N 1ST AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-8603
Practice Address - Country:US
Practice Address - Phone:520-318-6035
Practice Address - Fax:520-795-9953
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ23966207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ384462Medicaid
AZZ102883Medicare PIN
AZ384462Medicaid