Healthcare Provider Details

I. General information

NPI: 1841291804
Provider Name (Legal Business Name): BRANDON JUDE ABEYTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/07/2023
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 N CAMPBELL AVE SUITE 110
TUCSON AZ
85719-2380
US

IV. Provider business mailing address

645 E MISSOURI AVE STE 300
PHOENIX AZ
85012-1351
US

V. Phone/Fax

Practice location:
  • Phone: 520-795-7650
  • Fax:
Mailing address:
  • Phone: 602-262-8900
  • Fax: 602-262-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberL9049
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2003-0436
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number51249
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: