Provider Demographics
NPI:1316973175
Name:BRONSTEIN, GERALD S (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:S
Last Name:BRONSTEIN
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 1:503 EL CAMINO RD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5171
Mailing Address - Country:US
Mailing Address - Phone:928-282-2791
Mailing Address - Fax:
Practice Address - Street 1:2530 W HWY 89A
Practice Address - Street 2:BLDG A
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336
Practice Address - Country:US
Practice Address - Phone:928-203-4813
Practice Address - Fax:928-203-0201
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ22947208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ503434Medicaid
AZZ105337Medicare PIN
AZ503434Medicaid