Provider Demographics
NPI:1356738009
Name:MENG, GHARETT (MD)
Entity type:Individual
Prefix:DR
First Name:GHARETT
Middle Name:
Last Name:MENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GHARETT
Other - Middle Name:OWEN
Other - Last Name:MENG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2601 E. ROOSEVELT ST.
Mailing Address - Street 2:MARICOPA INTEGRATED HEALTH SYSTEM
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008
Mailing Address - Country:US
Mailing Address - Phone:406-396-6397
Mailing Address - Fax:
Practice Address - Street 1:2601 E. ROOSEVELT ST.
Practice Address - Street 2:MARICOPA INTEGRATED HEALTH SYSTEM
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008
Practice Address - Country:US
Practice Address - Phone:406-396-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IDM-14019207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program