MEDICARE: DR. CUAUHTEMOC GALLARDO-PRADO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	R71439	AZ
2	208D00000X	General Practice Physician	67041	AZ
3	207Q00000X	Family Medicine Physician	67041	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700116605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CUAUHTEMOC GALLARDO-PRADO M.D.

Provider Business Mailing Address
First Line	:	102 WOODMONT BLVD STE 600
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-5250
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 E SOUTHERN AVE STE 106
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-5058
Country	:	US
Telephone Number	:	480-870-7400
Fax Number	:	480-906-2174

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2009
Last Update Date	:	05/23/2025

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Directions to “ DR. CUAUHTEMOC GALLARDO-PRADO M.D.” Practice Location

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