Healthcare Provider Details

I. General information

NPI: 1851912224
Provider Name (Legal Business Name): BRAD GUTHRIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 E BASELINE RD STE 108
MESA AZ
85206-4616
US

IV. Provider business mailing address

4540 E BASELINE RD STE 108
MESA AZ
85206-4616
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-3880
  • Fax:
Mailing address:
  • Phone: 480-892-3880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number69516
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: