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General NPI Number Information
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NPI Number | 1285854562
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Entity Type | Individual
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Provider Name | BRIAN GEORGE MISCALL MD
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Gender | Male
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6501 SAN ANTONIO DR NE #803
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4139
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Country | US
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Telephone | 505-299-0836
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Fax |
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Provider Business Mailing Address
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Address Line | 8100 WYOMING BLVD NE M-4 #285
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1963
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Country | US
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Telephone | 505-299-0836
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 77-223
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License Number State | NM
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