Healthcare Provider Details

I. General information

NPI: 1831557321
Provider Name (Legal Business Name): ARIZONA ALLERGY AND ASTHMA SPECIALISTS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16611 S 40TH ST SUITE 170
PHOENIX AZ
85048-0562
US

IV. Provider business mailing address

16611 S 40TH ST SUITE 170
PHOENIX AZ
85048-0562
US

V. Phone/Fax

Practice location:
  • Phone: 480-705-8844
  • Fax: 480-705-8838
Mailing address:
  • Phone: 480-705-8844
  • Fax: 480-705-8838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number21604
License Number StateAZ

VIII. Authorized Official

Name: DR. BRIAN WADE MILLHOLLON
Title or Position: DOCTOR/PRESIDENT
Credential: M.D.
Phone: 480-705-8844