Individual
DANIEL JOSEPH GRAVDAHL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4207 E COTTON CENTER BLVD., BUILDING 10, PHOENIX, AZ 85040
(888) 276-2223
(972) 767-0225
Mailing address
PO BOX 840294, DALLAS, TX 75284-0294
(888) 344-1160
(972) 331-3148
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
44276
AZ
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
81039
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81039
TRAINING PERMIT
AZ
Enumeration date
08/06/2007
Last updated
11/25/2013
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