Provider Demographics
NPI:1124093539
Name:MAGGASS, GREGORY A (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:MAGGASS
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:PO BOX 3106
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90078-3106
Mailing Address - Country:US
Mailing Address - Phone:480-922-4600
Mailing Address - Fax:480-922-5231
Practice Address - Street 1:9055 E DEL CAMINO DR
Practice Address - Street 2:STE 200
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2351
Practice Address - Country:US
Practice Address - Phone:480-922-4600
Practice Address - Fax:480-922-5231
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ170592085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ270687OtherAHCCCS
AZZ126799Medicare PIN
AZZ30WCHJD01Medicare PIN
AZ270687OtherAHCCCS