Individual
CORY MATTHEW GINGOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1000 N HUMPHREYS ST, SUITE 104, FLAGSTAFF, AZ 86001-3136
(928) 779-3844
(928) 779-3848
Mailing address
2550 N THUNDERBIRD CIR, STE 303, MESA, AZ 85215-1214
(480) 435-9132
(480) 776-0025
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
2243
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
532433
—
AZ
Enumeration date
06/06/2006
Last updated
05/03/2017
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