Healthcare Provider Details

I. General information

NPI: 1427049873
Provider Name (Legal Business Name): BRYAN W GAWLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8913 E. BELL RD BLDG E, SUITE. 101-B
SCOTTSDALE AZ
85260
US

IV. Provider business mailing address

8913 E BELL RD BLDG E, SUITE 101-B
SCOTTSDALE AZ
85260-1598
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-2173
  • Fax: 480-656-9735
Mailing address:
  • Phone: 480-860-2173
  • Fax: 480-656-9735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number33914
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: