Healthcare Provider Details

I. General information

NPI: 1760864300
Provider Name (Legal Business Name): BRANDON WOLFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST STE 4000
PHOENIX AZ
85020-2432
US

IV. Provider business mailing address

9250 N 3RD ST STE 4000
PHOENIX AZ
85020-2432
US

V. Phone/Fax

Practice location:
  • Phone: 602-633-3800
  • Fax: 602-861-3500
Mailing address:
  • Phone: 602-633-3800
  • Fax: 602-633-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2015017866
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD2022-0751
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number72771
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: