Provider Demographics
NPI:1225092745
Name:GRADO, GORDON LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:LOUIS
Last Name:GRADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 N CIVIC CENTER PLZ
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6902
Mailing Address - Country:US
Mailing Address - Phone:480-614-6300
Mailing Address - Fax:480-614-6333
Practice Address - Street 1:2926 N CIVIC CENTER PLZ
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6902
Practice Address - Country:US
Practice Address - Phone:480-614-6300
Practice Address - Fax:480-614-6333
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174872085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ351114Medicaid
A02892Medicare UPIN
AZ29159Medicare ID - Type Unspecified