Provider Demographics
NPI:1851791347
Name:GIFFORD, MICHAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:GIFFORD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 W 25TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6924
Mailing Address - Country:US
Mailing Address - Phone:928-955-0777
Mailing Address - Fax:888-440-5343
Practice Address - Street 1:1951 W 25TH ST STE E
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6924
Practice Address - Country:US
Practice Address - Phone:928-955-0777
Practice Address - Fax:888-440-5343
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPOD-000846213ES0103X
AZ846213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ260797Medicaid