Provider Demographics
NPI:1194821975
Name:GRIDLEY, DANIEL G (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:GRIDLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3200 N CENTRAL AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2425
Mailing Address - Country:US
Mailing Address - Phone:602-406-3729
Mailing Address - Fax:602-798-9412
Practice Address - Street 1:350 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4409
Practice Address - Country:US
Practice Address - Phone:602-406-3430
Practice Address - Fax:602-406-4058
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ342072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology