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General NPI Number Information
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NPI Number | 1235524919
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Entity Type | Individual
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Provider Name | BRIAN CRIPE M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 1020 N SAN FRANCISCO ST STE 200
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3281
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Country | US
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Telephone | 928-774-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 N SAN FRANCISCO ST STE 200
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3281
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Country | US
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Telephone | 928-220-5447
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 65929
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License Number State | AZ
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