Provider Demographics
NPI:1730145053
Name:GRAMSTAD, NORMAN DEAN (DO)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:DEAN
Last Name:GRAMSTAD
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:PO BOX 41908
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-1908
Mailing Address - Country:US
Mailing Address - Phone:602-973-3100
Mailing Address - Fax:602-973-0978
Practice Address - Street 1:7550 N 19TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7976
Practice Address - Country:US
Practice Address - Phone:602-973-3100
Practice Address - Fax:602-973-0978
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3181208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ982117Medicaid
AZZ111110Medicare PIN
AZ982117Medicaid