Healthcare Provider Details

I. General information

NPI: 1417952789
Provider Name (Legal Business Name): JOEL VICTOR BRILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 E DENTON LN
PARADISE VALLEY AZ
85253-7508
US

IV. Provider business mailing address

3639 E DENTON LN
PARADISE VALLEY AZ
85253-7508
US

V. Phone/Fax

Practice location:
  • Phone: 602-418-8744
  • Fax: 480-452-0424
Mailing address:
  • Phone: 602-418-8744
  • Fax: 480-452-0424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25553
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: