Provider Demographics
NPI:1104914472
Name:SCHWARTZBERG, GERALD (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:SCHWARTZBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 N 2ND ST
Mailing Address - Street 2:121
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020
Mailing Address - Country:US
Mailing Address - Phone:602-997-7331
Mailing Address - Fax:602-870-4512
Practice Address - Street 1:9100 N 2ND ST
Practice Address - Street 2:#121
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:602-997-7331
Practice Address - Fax:602-870-4512
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5243207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ219354Medicaid
AZ219354Medicaid
AZ29WCHKV01Medicare ID - Type Unspecified