Healthcare Provider Details

I. General information

NPI: 1467652875
Provider Name (Legal Business Name): IAN KAY BRIMHALL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 HIGHWAY 260 STE 103
LAKESIDE AZ
85929-5845
US

IV. Provider business mailing address

4830 HIGHWAY 260 STE 103
LAKESIDE AZ
85929-5851
US

V. Phone/Fax

Practice location:
  • Phone: 928-537-8777
  • Fax: 928-537-1914
Mailing address:
  • Phone: 928-537-8777
  • Fax: 928-537-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4782
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101015602
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number191513
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: