Healthcare Provider Details

I. General information

NPI: 1154350817
Provider Name (Legal Business Name): DANIEL JAMES BRICELAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13624 W CAMINO DEL SOL STE 200
SUN CITY WEST AZ
85375-3401
US

IV. Provider business mailing address

13624 W CAMINO DEL SOL STE 200
SUN CITY WEST AZ
85375-3401
US

V. Phone/Fax

Practice location:
  • Phone: 623-546-2020
  • Fax: 623-546-2399
Mailing address:
  • Phone: 623-546-2020
  • Fax: 623-546-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number18851
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: