Provider Demographics
NPI:1275722712
Name:SOUTHWEST DIGESTIVE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:SOUTHWEST DIGESTIVE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:C
Authorized Official - Last Name:GELZAYD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-476-7273
Mailing Address - Street 1:10250 N 92ND ST
Mailing Address - Street 2:206
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4510
Mailing Address - Country:US
Mailing Address - Phone:480-767-7273
Mailing Address - Fax:
Practice Address - Street 1:10250 N 92ND ST
Practice Address - Street 2:206
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4510
Practice Address - Country:US
Practice Address - Phone:480-767-7273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35184174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty