Provider Demographics
NPI:1932150927
Name:MOERSCH, GARY ROBERT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ROBERT
Last Name:MOERSCH
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 1:40 S KYRENE RD
Mailing Address - Street 2:STE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-4675
Mailing Address - Country:US
Mailing Address - Phone:480-924-9797
Mailing Address - Fax:480-924-9805
Practice Address - Street 1:6820 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-3705
Practice Address - Country:US
Practice Address - Phone:480-924-9797
Practice Address - Fax:480-924-9805
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1514363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMM0003664OtherDEA REGISTRATION
AZZ103721Medicare PIN
AZMM0003664OtherDEA REGISTRATION