Basic Information
Provider Information | |||||||||
NPI: | 1528345881 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | AFC PHYSICAL MEDICINE OF GILBERT, PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
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OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
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OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1839 S ALMA SCHOOL RD STE 354 | ||||||||
Address2: |   | ||||||||
City: | MESA | ||||||||
State: | AZ | ||||||||
PostalCode: | 852103028 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4807262287 | ||||||||
FaxNumber: | 8883169272 | ||||||||
Practice Location | |||||||||
Address1: | 3011 S LINDSAY RD STE 101 | ||||||||
Address2: |   | ||||||||
City: | GILBERT | ||||||||
State: | AZ | ||||||||
PostalCode: | 852954333 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4807262500 | ||||||||
FaxNumber: | 4807262131 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/14/2011 | ||||||||
LastUpdateDate: | 12/08/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BOCK | ||||||||
AuthorizedOfficialFirstName: | JOSHUA | ||||||||
AuthorizedOfficialMiddleName: | F. | ||||||||
AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
AuthorizedOfficialTelephone: | 4807262287 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
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NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 7034950001 | AZ | N |   | Suppliers | Durable Medical Equipment & Medical Supplies |   | 208100000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |   |
No ID Information.