Individual
GREGG A ELBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
5777 E MAYO BLVD, PHOENIX, AZ 85054-4502
(480) 301-8000
Mailing address
640 S STATE ST, DOVER, DE 19901-3530
(302) 526-1470
(302) 674-1398
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2079
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140005371
RAILROAD MEDICARE
AZ
05
—
404301
—
AZ
01
—
86080015085259A373
TRIWEST
AZ
Enumeration date
11/20/2005
Last updated
01/10/2019
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