Healthcare Provider Details

I. General information

NPI: 1184638264
Provider Name (Legal Business Name): BRIAN J DEGUZMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10104 E CLINTON ST
SCOTTSDALE AZ
85260-6339
US

IV. Provider business mailing address

10104 E CLINTON ST
SCOTTSDALE AZ
85260-6339
US

V. Phone/Fax

Practice location:
  • Phone: 917-703-0212
  • Fax:
Mailing address:
  • Phone: 917-703-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number35855
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35855
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: