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Organization
59TH AVENUE SURGICAL FACILITY, LTD
Active
Organization
59TH AVENUE SURGICAL FACILITY, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK RICHARD GORMAN D.P.M. (C.E.O.)
(623) 934-3211
Entity
Organization
Contact information
Practice address
8608 N 59TH AVE, GLENDALE, AZ 85302-5404
(623) 934-3211
(623) 930-1891
Mailing address
8608 N 59TH AVE, GLENDALE, AZ 85302-5404
(623) 934-3211
(623) 930-1891
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
Other
Enumeration date
04/10/2007
Last updated
08/22/2020
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