Basic Information
| Provider Information | |||||||||
| NPI: | 1407955065 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAUSE | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | P.A.-C | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GAUSE | ||||||||
| OtherFirstName: | BILL | ||||||||
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| OtherCredential: | P.A.-C. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6301 S MCCLINTOCK DR | ||||||||
| Address2: | #101 | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852833392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802142300 | ||||||||
| FaxNumber: | 4802142301 | ||||||||
| Practice Location | |||||||||
| Address1: | 2550 E GUADALUPE RD | ||||||||
| Address2: | #115 | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852345114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806321544 | ||||||||
| FaxNumber: | 4806321533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 10/03/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 2267 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.