Healthcare Provider Details

I. General information

NPI: 1437186335
Provider Name (Legal Business Name): BRIAN J DELISIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4838 E BASELINE RD STE 108
MESA AZ
85206
US

IV. Provider business mailing address

4838 E BASELINE RD STE 108
MESA AZ
85206-4672
US

V. Phone/Fax

Practice location:
  • Phone: 480-981-2400
  • Fax:
Mailing address:
  • Phone: 480-981-2400
  • Fax: 480-981-2407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number33634
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number33634
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: