Provider Demographics
NPI:1447224548
Name:BRADY, CRAIG GILBERT (DO)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:GILBERT
Last Name:BRADY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E SHOW LOW LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7831
Mailing Address - Country:US
Mailing Address - Phone:928-537-6700
Mailing Address - Fax:928-532-3509
Practice Address - Street 1:4951 S WHITE MOUNTAIN RD BLDG A
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7827
Practice Address - Country:US
Practice Address - Phone:928-537-6700
Practice Address - Fax:928-532-2199
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3459207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ478885Medicaid
AZ67691Medicare PIN
AZH11025Medicare UPIN