Organization
GARY W EDEN DO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY W EDEN D.O (OWNER)
(480) 644-0424
Entity
Organization
Contact information
Practice address
5440 E SOUTHERN AVE, SUITE 105, MESA, AZ 85206-2779
(480) 644-0424
(480) 644-0926
Mailing address
5440 E SOUTHERN AVE, SUITE 105, MESA, AZ 85206-2779
(480) 644-0424
(480) 644-0926
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
1795
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274936
—
AZ
Enumeration date
01/29/2007
Last updated
09/21/2009
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