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General NPI Number Information
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NPI Number | 1831557321
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Entity Type | Organization
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Legal Business Name | ARIZONA ALLERGY AND ASTHMA SPECIALISTS P C
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Dates
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Enumeration Date | 01/29/2016
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Last Update Date | 10/29/2021
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Provider Practice Location Address
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Address Line | 16611 S 40TH ST SUITE 170
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City | PHOENIX
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State | AZ
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Zip | 85048-0562
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Country | US
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Telephone | 480-705-8844
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Fax | 480-705-8838
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Provider Business Mailing Address
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Address Line | 16611 S 40TH ST SUITE 170
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City | PHOENIX
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State | AZ
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Zip | 85048-0562
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Country | US
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Telephone | 480-705-8844
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Fax | 480-705-8838
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Authorized Official
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Title or Position | DOCTOR/PRESIDENT
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Name | DR. BRIAN WADE MILLHOLLON
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Credential | M.D.
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Telephone | 480-705-8844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 21604
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License Number State | AZ
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