Healthcare Provider Details

I. General information

NPI: 1700865763
Provider Name (Legal Business Name): BRIAN J. KARTCHNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S. 20TH AVENUE
SAFFORD AZ
85546
US

IV. Provider business mailing address

1300 S. 20TH AVENUE
SAFFORD AZ
85546
US

V. Phone/Fax

Practice location:
  • Phone: 928-428-3122
  • Fax: 928-428-7917
Mailing address:
  • Phone: 928-428-3122
  • Fax: 928-428-7917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21587
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: