MEDICARE: DR. CHARLES REDMOND BREED MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	10034	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	628739	OTHER	AZ	VA BCBS
2	00004310	OTHER	AZ	BANNER HEALTH PLANS
3	1Z1867	OTHER	AZ	HEALTHNET
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104813872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES REDMOND BREED MD

Provider Business Mailing Address
First Line	:	2055 E SOUTHERN AVE
Second Line	:	SUITE F
City	:	TEMPE
State	:	AZ
Zip	:	85282-7507
Country	:	US
Telephone Number	:	480-897-8484
Fax Number	:	480-897-8631

Provider Business Practice Location Address
First Line	:	2055 E SOUTHERN AVE
Second Line	:	SUITE F
City	:	TEMPE
State	:	AZ
Zip	:	85282-7507
Country	:	US
Telephone Number	:	480-897-8484
Fax Number	:	480-897-8631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2005
Last Update Date	:	09/27/2007

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