Healthcare Provider Details

I. General information

NPI: 1053724104
Provider Name (Legal Business Name): BRANDON M MINZER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 E ELWOOD ST STE 600
PHOENIX AZ
85040-1984
US

IV. Provider business mailing address

MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT STREET
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 602-200-9021
  • Fax:
Mailing address:
  • Phone: 617-726-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberL-259327
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number55694
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: