Individual
BRETT SHANE GOCHNOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
150 E TYSON ROAD, QUARTZSITE, AZ 85346
(928) 927-8747
(928) 927-8748
Mailing address
1200 W MOHAVE RD, PARKER, AZ 85344-6349
(928) 669-7311
(928) 669-7415
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4481
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
230943
—
AZ
01
—
4481
AZ STATE LICENSE
AZ
01
—
Z196548
MEDICARE NUMBER
AZ
Enumeration date
08/02/2006
Last updated
03/07/2023
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