Provider Demographics
NPI:1427049873
Name:GAWLEY, BRYAN W (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:W
Last Name:GAWLEY
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 1:8913 E BELL RD
Mailing Address - Street 2:BLDG E, SUITE 101-B
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1598
Mailing Address - Country:US
Mailing Address - Phone:480-860-2173
Mailing Address - Fax:480-656-9735
Practice Address - Street 1:8913 E. BELL RD
Practice Address - Street 2:BLDG E, SUITE. 101-B
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-860-2173
Practice Address - Fax:480-656-9735
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33914208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ948846Medicaid
AZ948846Medicaid
AZI37007Medicare UPIN