Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 42219 | AZ |
NPI | 1235324518 |
---|---|
Provider Name | Mark Gimbel |
First Address | Gilbert, AZ 85234-2165 |
Second Address | Gilbert, AZ 85234-2165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2007 |
Last Update Date | 06/03/2015 |