Healthcare Provider Details

I. General information

NPI: 1467716639
Provider Name (Legal Business Name): GRAYHAWK MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 09/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 E THOMPSON PEAK PKWY SUITE 100
SCOTTSDALE AZ
85255-7402
US

IV. Provider business mailing address

7920 E THOMPSON PEAK PKWY SUITE 100
SCOTTSDALE AZ
85255-7402
US

V. Phone/Fax

Practice location:
  • Phone: 480-661-1679
  • Fax: 480-661-4125
Mailing address:
  • Phone: 480-661-1679
  • Fax: 480-661-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL D. NUNEZ
Title or Position: OWNER
Credential: MD
Phone: 480-661-1679