Provider Demographics
NPI:1639232697
Name:GAWLEY PLASTIC SURGERY
Entity Type:Organization
Organization Name:GAWLEY PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-860-2173
Mailing Address - Street 1:8913 E BELL RD
Mailing Address - Street 2:BUILDING E, SUITE 101-B
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1598
Mailing Address - Country:US
Mailing Address - Phone:480-860-2173
Mailing Address - Fax:480-656-9735
Practice Address - Street 1:8913 E BELL RD
Practice Address - Street 2:BUILDING E, SUITE 101-B
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1598
Practice Address - Country:US
Practice Address - Phone:480-860-2173
Practice Address - Fax:480-656-9735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33914174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ104596Medicare PIN
AZZ104595Medicare PIN
AZI137007Medicare UPIN