Provider Demographics
NPI:1477527851
Name:CRAIG BRADY DO PC
Entity Type:Organization
Organization Name:CRAIG BRADY DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NPI
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-537-4347
Mailing Address - Street 1:151 N WHITE MOUNTAIN RD STE E
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-5298
Mailing Address - Country:US
Mailing Address - Phone:928-537-4347
Mailing Address - Fax:928-537-4348
Practice Address - Street 1:151 N WHITE MOUNTAIN RD STE E
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-5298
Practice Address - Country:US
Practice Address - Phone:928-537-4347
Practice Address - Fax:928-537-4348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ67690Medicare PIN