Provider Demographics
NPI:1982629978
Name:SURGICAL PROFESSIONALS, INC
Entity Type:Organization
Organization Name:SURGICAL PROFESSIONALS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-202-0604
Mailing Address - Street 1:2558 S RIATA CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-5948
Mailing Address - Country:US
Mailing Address - Phone:480-202-0604
Mailing Address - Fax:480-892-2458
Practice Address - Street 1:4135 S POWER RD
Practice Address - Street 2:SUITE 117
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3624
Practice Address - Country:US
Practice Address - Phone:480-545-2610
Practice Address - Fax:480-545-2673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22813208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG32696Medicare UPIN