Provider Demographics
NPI:1588777387
Name:GENTILE, MARK J (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:GENTILE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2680 S VAL VISTA DR
Mailing Address - Street 2:STE 167
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1638
Mailing Address - Country:US
Mailing Address - Phone:480-857-0222
Mailing Address - Fax:480-857-0020
Practice Address - Street 1:2680 S VAL VISTA DR
Practice Address - Street 2:STE 167
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1638
Practice Address - Country:US
Practice Address - Phone:480-857-0222
Practice Address - Fax:480-857-0020
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2021-03-02
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Provider Licenses
StateLicense IDTaxonomies
AZAZ12913208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ25172803Medicaid
D36897Medicare UPIN