Healthcare Provider Details

I. General information

NPI: 1114014727
Provider Name (Legal Business Name): BRIAN LLOYD CABIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 12/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

772N COUNTRY CLUB RD
TUCSON AZ
85716-4535
US

IV. Provider business mailing address

772N COUNTRY CLUB RD
TUCSON AZ
85716-4535
US

V. Phone/Fax

Practice location:
  • Phone: 520-319-2810
  • Fax: 520-319-2814
Mailing address:
  • Phone: 520-319-2810
  • Fax: 520-319-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13314
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: