Basic Information
| Provider Information | |||||||||
| NPI: | 1417266305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GILBERT NEUROLOGY PARTNERS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3507 S MERCY RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852970441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809260644 | ||||||||
| FaxNumber: | 4809260645 | ||||||||
| Practice Location | |||||||||
| Address1: | 3507 S MERCY RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852970441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809260644 | ||||||||
| FaxNumber: | 4809260645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2010 | ||||||||
| LastUpdateDate: | 07/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | HODGSON | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | JOINT OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4809260644 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 07/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 4335 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.