Provider Demographics
NPI:1871692574
Name:ERBSTOESSER, GARY A (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:ERBSTOESSER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 E BELL ROAD
Mailing Address - Street 2:ST. 5300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032
Mailing Address - Country:US
Mailing Address - Phone:602-246-0351
Mailing Address - Fax:602-246-7023
Practice Address - Street 1:3805 E BELL ROAD
Practice Address - Street 2:ST. 5300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032
Practice Address - Country:US
Practice Address - Phone:602-246-0351
Practice Address - Fax:602-246-7023
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2751207Q00000X, 207QS0010X
AZ02751207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF80530Medicare UPIN
AZZ126512Medicare PIN