Provider Demographics
NPI:1093502247
Name:ELBERT, GARY
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:ELBERT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 N 79TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-2239
Mailing Address - Country:US
Mailing Address - Phone:928-679-3804
Mailing Address - Fax:
Practice Address - Street 1:1843 N 79TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-2239
Practice Address - Country:US
Practice Address - Phone:928-679-3804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach