MEDICARE: MARTIN BRANDT PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	2204	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801882154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN BRANDT PAC

Provider Business Mailing Address
First Line	:	4001 E SUNRISE DR STE 121
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-4324
Country	:	US
Telephone Number	:	520-209-7000
Fax Number	:	520-209-7010

Provider Business Practice Location Address
First Line	:	4001 E SUNRISE DR STE 121
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-4324
Country	:	US
Telephone Number	:	520-209-7000
Fax Number	:	520-209-7010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	10/01/2020

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Directions to “ MARTIN BRANDT PAC” Practice Location

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