Provider Demographics
NPI:1013941061
Name:NIRMUL, GOWEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GOWEN
Middle Name:
Last Name:NIRMUL
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 1:8360 E RAINTREE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2686
Mailing Address - Country:US
Mailing Address - Phone:623-546-1152
Mailing Address - Fax:623-546-9789
Practice Address - Street 1:14506 W GRANITE VALLEY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-6010
Practice Address - Country:US
Practice Address - Phone:623-546-1152
Practice Address - Fax:623-546-9789
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30953208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2Z1301OtherHEALTHNET
AZAZ0753520OtherBCBS
AZAZ0753520OtherBCBS