Healthcare Provider Details

I. General information

NPI: 1780666065
Provider Name (Legal Business Name): ROBERT ANDREW BRICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 S CAMPBELL RD
GREEN VALLEY AZ
85614-0502
US

IV. Provider business mailing address

2100 POWELL ST STE 900
EMERYVILLE CA
94608-1826
US

V. Phone/Fax

Practice location:
  • Phone: 520-625-3691
  • Fax: 520-625-2894
Mailing address:
  • Phone: 510-350-2600
  • Fax: 510-597-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21905
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: