Provider Demographics
NPI:1992793335
Name:RADA, GARY A (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:RADA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:602-214-6148
Mailing Address - Fax:602-214-6149
Practice Address - Street 1:18404 N TATUM BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1510
Practice Address - Country:US
Practice Address - Phone:602-992-1900
Practice Address - Fax:602-485-7450
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2013-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ4731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ99209OtherMAYO
AZ224048Medicaid
AZ378583200OtherDEPT OF LABOR
AZ01-00255OtherUNITED HEALTH CARE
AZ1070141OtherCIGNA
AS5028029OtherCCN
AZAZ0805140OtherBLUE CROSS BLUE SHIELD
AZ080100694OtherRAILROAD MEDICARE
AZ1Z1035OtherHEALTHNET
AZ4071670OtherAETNA
AZ73522OtherFIRST HEALTH
AZ224048Medicaid
AZ73522OtherFIRST HEALTH