Provider Demographics
NPI:1700942117
Name:GRAYDEN, THOMAS J (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:GRAYDEN
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 1:3101 N CENTRAL AVE STE 550
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2635
Mailing Address - Country:US
Mailing Address - Phone:602-230-7373
Mailing Address - Fax:602-682-7455
Practice Address - Street 1:750 E THUNDERBIRD RD STE 1-3
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5306
Practice Address - Country:US
Practice Address - Phone:602-230-7373
Practice Address - Fax:602-218-6383
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2024-07-24
Deactivation Date:2023-12-20
Deactivation Code:
Reactivation Date:2024-01-24
Provider Licenses
StateLicense IDTaxonomies
CAG504012084P0800X
AZ673162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry