Healthcare Provider Details

I. General information

NPI: 1699095976
Provider Name (Legal Business Name): CHAD BURDAL BRIMHALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 S MAIN ST
SNOWFLAKE AZ
85937-5645
US

IV. Provider business mailing address

1121 S MAIN ST
SNOWFLAKE AZ
85937-5645
US

V. Phone/Fax

Practice location:
  • Phone: 928-536-5858
  • Fax: 928-536-2196
Mailing address:
  • Phone: 928-536-5858
  • Fax: 928-536-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number48077
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR72084
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: