Gateway Family Medicine | |
4365 E Pecos Rd Suite 134 Gilbert AZ 85295-8053 | |
(480) 840-9155 | |
(480) 840-9320 |
Full Name | Gateway Family Medicine |
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Speciality | Family Medicine |
Location | 4365 E Pecos Rd, Gilbert, Arizona |
Authorized Official Name and Position | Timothy C Bryan (OWNER MANAGER) |
Authorized Official Contact | 4808409155 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Gateway Family Medicine 4365 E Pecos Rd Suite 134 Gilbert AZ 85295-8053 Ph: (480) 840-9155 | Gateway Family Medicine 4365 E Pecos Rd Suite 134 Gilbert AZ 85295-8053 Ph: (480) 840-9155 |
NPI Number | 1124224126 |
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Provider Enumeration Date | 06/26/2007 |
Last Update Date | 12/22/2011 |
Medicare PECOS PAC ID | 0345341863 |
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Medicare Enrollment ID | O20070726000759 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124224126 | NPI | - | NPPES |
104591 | Medicaid | AZ |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 35487 (Arizona) | Primary |
Provider Name | Timothy C Bryan |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1831133743 PECOS PAC ID: 3577532878 Enrollment ID: I20060811000420 |
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