Provider Demographics
NPI:1811966856
Name:GUSS, CLIFFORD J (PA-C)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:J
Last Name:GUSS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 W THUNDERBIRD RD STE A100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4661
Mailing Address - Country:US
Mailing Address - Phone:602-938-3205
Mailing Address - Fax:602-938-5799
Practice Address - Street 1:5750 W THUNDERBIRD RD STE A100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4661
Practice Address - Country:US
Practice Address - Phone:602-938-3205
Practice Address - Fax:602-938-5799
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2984363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMG1090428OtherDEA
AZMG1090428OtherDEA