Provider Demographics
NPI:1982813739
Name:GRADY, MATTHEW J (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:GRADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2758
Mailing Address - Street 2:4150 KIMBALL AVE
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-235-5390
Mailing Address - Fax:319-233-1630
Practice Address - Street 1:1825 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1916
Practice Address - Country:US
Practice Address - Phone:319-235-5386
Practice Address - Fax:319-235-3074
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2014-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA38227207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1982813739Medicaid
IA421417307V1OtherUHC/RIVER VALLEY/JD PREMIER
IA421417307V1OtherUHC/RIVER VALLEY/JD PREMIER