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General NPI Number Information
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NPI Number | 1386444990
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Entity Type | Individual
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Provider Name | BRIAN PARKER
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Gender | Male
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 5757 W THUNDERBIRD RD STE E151
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City | GLENDALE
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State | AZ
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Zip | 85306-4685
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Country | US
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Telephone | 602-865-4570
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Fax | 602-865-4575
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Provider Business Mailing Address
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Address Line | 4136 W ALEX LOOP
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City | PHOENIX
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State | AZ
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Zip | 85083-2445
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Country | US
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Telephone | 279-333-9449
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 11369
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License Number State | AZ
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