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General NPI Number Information
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NPI Number | 1275722712
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Entity Type | Organization
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Legal Business Name | SOUTHWEST DIGESTIVE SPECIALISTS, LLC
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 04/04/2008
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Provider Practice Location Address
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Address Line | 10250 N 92ND ST 206
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4510
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Country | US
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Telephone | 480-767-7273
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Fax |
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Provider Business Mailing Address
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Address Line | 10250 N 92ND ST 206
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4510
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Country | US
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Telephone | 480-767-7273
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. BRADFORD C GELZAYD
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Credential | M.D.
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Telephone | 480-476-7273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35184
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License Number State | AZ
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