Healthcare Provider Details

I. General information

NPI: 1447224548
Provider Name (Legal Business Name): CRAIG GILBERT BRADY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4951 S WHITE MOUNTAIN RD BLDG A
SHOW LOW AZ
85901-7827
US

IV. Provider business mailing address

2200 E SHOW LOW LAKE RD
SHOW LOW AZ
85901-7831
US

V. Phone/Fax

Practice location:
  • Phone: 928-537-6700
  • Fax: 928-532-2199
Mailing address:
  • Phone: 928-537-6700
  • Fax: 928-532-3509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3459
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: