Basic Information
| Provider Information | |||||||||
| NPI: | 1821275231 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GENDY | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6320 W UNION HILLS DR STE 1800 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853081372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804200749 | ||||||||
| FaxNumber: | 4804200732 | ||||||||
| Practice Location | |||||||||
| Address1: | 19636 N 27TH AVE | ||||||||
| Address2: | STE 401 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022988888 | ||||||||
| FaxNumber: | 6029784129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2008 | ||||||||
| LastUpdateDate: | 09/19/2019 | ||||||||
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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 | 174400000X | 49481 | AZ | N | Other Service Providers | Specialist | 207X00000X | 49481 | AZ | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207XX0004X | 49481 | AZ | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | AZ | MEDICAID |