Healthcare Provider Details

I. General information

NPI: 1699025494
Provider Name (Legal Business Name): ERIK-BRANDON CLEMENT BUZAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8520 E SHEA BLVD STE 100
SCOTTSDALE AZ
85260-6677
US

IV. Provider business mailing address

8520 E SHEA BLVD STE 100
SCOTTSDALE AZ
85260-6677
US

V. Phone/Fax

Practice location:
  • Phone: 480-588-6924
  • Fax:
Mailing address:
  • Phone: 480-588-6924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5148
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: