Provider Demographics
NPI:1952481152
Name:GORDON GRADO, M.D., INC
Entity Type:Organization
Organization Name:GORDON GRADO, M.D., INC
Other - Org Name:SOUTHWEST ONCOLOGY CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:GRADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-614-6300
Mailing Address - Street 1:2926 N CIVIC CENTER PLZ
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6902
Mailing Address - Country:US
Mailing Address - Phone:480-614-6300
Mailing Address - Fax:480-614-6333
Practice Address - Street 1:2926 N CIVIC CENTER PLZ
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6902
Practice Address - Country:US
Practice Address - Phone:480-614-6300
Practice Address - Fax:480-614-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ29158Medicare PIN