Healthcare Provider Details

I. General information

NPI: 1235524919
Provider Name (Legal Business Name): BRIAN CRIPE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N SAN FRANCISCO ST STE 200
FLAGSTAFF AZ
86001-3281
US

IV. Provider business mailing address

1020 N SAN FRANCISCO ST STE 200
FLAGSTAFF AZ
86001-3281
US

V. Phone/Fax

Practice location:
  • Phone: 928-774-2300
  • Fax:
Mailing address:
  • Phone: 928-220-5447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number65929
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: