Provider Demographics
NPI:1215743927
Name:GMYREK, JOSHUA JAMES
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JAMES
Last Name:GMYREK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 E CHAUNCEY LN APT 3137
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5144
Mailing Address - Country:US
Mailing Address - Phone:612-715-0793
Mailing Address - Fax:
Practice Address - Street 1:6901 E CHAUNCEY LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5101
Practice Address - Country:US
Practice Address - Phone:612-715-0793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant