Individual
DR. GARY DOUGLAS GRIDLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
269 S CANDY LN, COTTONWOOD, AZ 86326-4158
(928) 639-6150
(928) 639-6561
Mailing address
1200 N BEAVER ST, PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
30200
AZ
207L00000X
Anesthesiology Physician
MD00030603
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0181547
DEPT OF LABOR & INDUSTRIE
WA
01
—
5647GR
REGENCE BLUE SHIELD
WA
05
—
8312498
—
WA
01
—
8930278
CRIME VICTIMS PGM
WA
Enumeration date
11/08/2005
Last updated
10/18/2022
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