Healthcare Provider Details

I. General information

NPI: 1225092745
Provider Name (Legal Business Name): GORDON LOUIS GRADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 06/21/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2926 N CIVIC CENTER PLZ
SCOTTSDALE AZ
85251-6902
US

IV. Provider business mailing address

2926 N CIVIC CENTER PLZ
SCOTTSDALE AZ
85251-6902
US

V. Phone/Fax

Practice location:
  • Phone: 480-614-6300
  • Fax: 480-614-6333
Mailing address:
  • Phone: 480-614-6300
  • Fax: 480-614-6333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number17487
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number17487
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: