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General NPI Number Information
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NPI Number | 1821282666
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Entity Type | Organization
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Legal Business Name | BRIAN S. PAGE D.O. P.L.L.C.
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 09/05/2007
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Provider Practice Location Address
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Address Line | 20325 N 51ST AVE BLDG 8 SUITE 160
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City | GLENDALE
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State | AZ
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Zip | 85308-5674
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Country | US
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Telephone | 602-942-0833
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Fax |
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Provider Business Mailing Address
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Address Line | 20325 N 51ST AVE BLDG 8 SUITE 160
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City | GLENDALE
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State | AZ
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Zip | 85308-5674
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Country | US
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Telephone | 602-942-0833
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN PAGE
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Credential | D.O.
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Telephone | 602-942-0833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 3416
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License Number State | AZ
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