Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | D008375 | AZ |
N | 1223D0004X | Dentist Anesthesiologist | 30599 | TX |
N | 1223D0004X | Dentist Anesthesiologist | 3827-15 | MS |
N | 1223D0004X | Dentist Anesthesiologist | 60944 | CA |
Y | 1223D0004X | Dentist Anesthesiologist | D008375 | AZ |
NPI | 1841553120 |
---|---|
Provider Name | Dr. Jason Wayne Brady |
First Address | Gilbert, AZ 85234-0019 |
Second Address | Gilbert, AZ 85234-0019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2012 |
Last Update Date | 03/09/2015 |