Healthcare Provider Details

I. General information

NPI: 1942292024
Provider Name (Legal Business Name): BRIAN E TRAINOR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 S MERCY RD STE 107
GILBERT AZ
85297-0419
US

IV. Provider business mailing address

4827 W SADDLEHORN RD
PHOENIX AZ
85083-2219
US

V. Phone/Fax

Practice location:
  • Phone: 480-214-9000
  • Fax: 480-214-9999
Mailing address:
  • Phone: 480-945-6100
  • Fax: 623-266-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number4162
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: