Healthcare Provider Details

I. General information

NPI: 1194816702
Provider Name (Legal Business Name): BRAD GOLNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 E UNION HILLS DR
PHOENIX AZ
85050-3362
US

IV. Provider business mailing address

4735 E UNION HILLS DR
PHOENIX AZ
85050-3362
US

V. Phone/Fax

Practice location:
  • Phone: 602-971-5121
  • Fax: 602-971-3122
Mailing address:
  • Phone: 602-971-5121
  • Fax: 602-971-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24993
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: