Provider Demographics
NPI:1730154725
Name:GIMBEL, NEAL I (MD)
Entity type:Individual
Prefix:MR
First Name:NEAL
Middle Name:I
Last Name:GIMBEL
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 1:5605 W EUGIE AVE
Mailing Address - Street 2:STE 111
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1273
Mailing Address - Country:US
Mailing Address - Phone:602-298-8888
Mailing Address - Fax:602-938-2504
Practice Address - Street 1:5605 W EUGIE AVE
Practice Address - Street 2:STE 111
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1273
Practice Address - Country:US
Practice Address - Phone:602-298-8888
Practice Address - Fax:602-938-2504
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10350207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C99548Medicare UPIN
24788Medicare ID - Type Unspecified