Provider Demographics
NPI:1356332084
Name:BANDY, GREGORY L (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:BANDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S DOBSON RD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6481
Mailing Address - Country:US
Mailing Address - Phone:480-839-3469
Mailing Address - Fax:480-839-4182
Practice Address - Street 1:5102 W CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1703
Practice Address - Country:US
Practice Address - Phone:623-848-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16309207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ39-81220OtherEVERCARE GROUP
AZAW1936OtherHEALTHNET GROUP
AZ294819Medicaid
AZAZ0728670OtherBCBS GROUP
AZ104482Medicare ID - Type Unspecified
E45404Medicare UPIN