Provider Demographics
NPI:1174551014
Name:REIDY, JAMES MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:REIDY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 S VAL VISTA DR
Mailing Address - Street 2:BLDG 13, UNIT 175
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2152
Mailing Address - Country:US
Mailing Address - Phone:480-784-0110
Mailing Address - Fax:480-784-0220
Practice Address - Street 1:2680 S VAL VISTA DR
Practice Address - Street 2:BLDG 13, UNIT 175
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2152
Practice Address - Country:US
Practice Address - Phone:480-784-0110
Practice Address - Fax:480-784-0220
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4012207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0762840OtherBLUE CROSS OF AZ
AZ876617Medicaid
AZAZ0762840OtherBLUE CROSS OF AZ
AZI17061Medicare UPIN