Provider Demographics
NPI:1831170570
Name:CARLOS, GERARDO (MD)
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:CARLOS
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:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-4111
Mailing Address - Fax:520-616-1442
Practice Address - Street 1:2055 W HOSPITAL DR STE 115
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7823
Practice Address - Country:US
Practice Address - Phone:520-797-0011
Practice Address - Fax:520-797-7550
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15877207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ275554Medicaid
AZ275554Medicaid
AZFQ21801AKMedicare ID - Type Unspecified