DR. GREGORY J FENZL D.O., NPI 1093787004 — PHOENIX (AZ)

NPI 1093787004

14+ Years Experience Individual

DR. GREGORY J FENZL D.O.

02.03.2006
PROVIDER ENUMERATION DATE
08.09.2017
LAST UPDATE DATE
1093787004
NPI NUMBER

About DR. GREGORY J FENZL

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

DR. GREGORY J FENZL is a provider established in PHOENIX, AZ. The NPI number of DR. GREGORY J FENZL is 1093787004 and was assigned on 02.03.2006. The practitioners primary taxonomy code is: 2085R0202X with license number: 4043 AZ .

Mailing address

  • City: PHOENIX
  • State: AZ
  • Postal code: 850293458
  • Phone: 6029439200
  • Fax: 6022163000
  • Address: 10835 N 25TH AVE
  • Address 2: STE 240

Primary Practice Address

  • Region : PHOENIX, AZ
  • NPI : 1093787004
  • Phone : 6238795720
  • Postalcode : 850274001
  • Address : 19829 N 27TH AVE

Additional identifiers

  • Identifier: 1Z7086
  • Code / Type : 1 - other
  • Identifier state : AZ
  • Identifier issuer: HEALTH NET OF ARIZONA

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Additional identifiers # 2

  • Identifier: 857568
  • Code / Type : 5 - MEDICAID
  • Identifier state : AZ

Provider taxonomy - Radiology

  • Taxonomy code: 2085R0202X
  • License number: 4043
  • License state: AZ

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Contacts:

Click to Show Map
  • DR. GREGORY J FENZL D.O.
  • Address : 19829 N 27TH AVE
  • Region : PHOENIX, AZ
  • NPI : 1093787004
  • Phone : 6238795720
  • Postalcode : 850274001

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address19829 N 27TH AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NamePHOENIX
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameAZ
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code850274001
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number6238795720
The telephone number associated with the location address of the provider being identified.
NPI1093787004
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 12085R0202X
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Provider Enumeration Date02.03.2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated08.09.2017
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)DR. GREGORY J FENZL
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address10835 N 25TH AVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressSTE 240
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NamePHOENIX
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameAZ
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code850293458
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number6029439200
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number6022163000
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #12085R0202X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Provider License Number 14043
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1AZ
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 11Z7086
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1AZ
Other Provider Identifier State #1
Other Provider Identifier Issuer 1HEALTH NET OF ARIZONA
Other Provider Identifier Issuer #1
Other Provider Identifier 2857568
Other Provider Identifier #2
Other Provider Identifier Type 25
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 2AZ
Other Provider Identifier State #2
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

Share this page?