Provider Demographics
NPI:1548257702
Name:STERN, GARY LOWELL (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LOWELL
Last Name:STERN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15615 N. 71ST STREET
Mailing Address - Street 2:SUITE #108
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2150
Mailing Address - Country:US
Mailing Address - Phone:480-773-7185
Mailing Address - Fax:480-718-9787
Practice Address - Street 1:15615 N. 71ST STREET
Practice Address - Street 2:SUITE #108
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2150
Practice Address - Country:US
Practice Address - Phone:480-773-7185
Practice Address - Fax:480-718-9787
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2013-02-19
Deactivation Date:2013-01-24
Deactivation Code:
Reactivation Date:2013-02-19
Provider Licenses
StateLicense IDTaxonomies
AZ37622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry