Basic Information
| Provider Information | |||||||||
| NPI: | 1356332084 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANDY | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 S DOBSON RD | ||||||||
| Address2: | SUITE 1100 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852026481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808393469 | ||||||||
| FaxNumber: | 4808394182 | ||||||||
| Practice Location | |||||||||
| Address1: | 5102 W CAMPBELL AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850311703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238485000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 16309 | AZ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 39-81220 | 01 | AZ | EVERCARE GROUP | OTHER | AW1936 | 01 | AZ | HEALTHNET GROUP | OTHER | 294819 | 05 | AZ | MEDICAID | AZ0728670 | 01 | AZ | BCBS GROUP | OTHER |