Provider Demographics
NPI:1316379142
Name:GARY L CRAINE, M.D., P.C.
Entity Type:Organization
Organization Name:GARY L CRAINE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CRAINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-282-0302
Mailing Address - Street 1:15416 S 16TH WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-4144
Mailing Address - Country:US
Mailing Address - Phone:480-282-0302
Mailing Address - Fax:480-941-1174
Practice Address - Street 1:3501 N SCOTTSDALE RD
Practice Address - Street 2:SUITE #250
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5648
Practice Address - Country:US
Practice Address - Phone:480-941-5266
Practice Address - Fax:480-941-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13396207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z21904Medicare UPIN