Provider Demographics
NPI:1215976907
Name:STOTSKY, GAIL (MD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:STOTSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:US 191 & AZ 264
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505
Practice Address - Country:US
Practice Address - Phone:928-755-4632
Practice Address - Fax:928-755-4831
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2023-0110208000000X
IN01042055A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100421030Medicaid
IN264430286Medicare PIN
INM400064942Medicare PIN
INE43613Medicare UPIN
IN100421030Medicaid