MEDICARE: BRIAN S. PAGE D.O. P.L.L.C.

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

General Provider Information

NPI Number	:	1205645447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN S. PAGE D.O. P.L.L.C.

Provider Business Mailing Address
First Line	:	20325 N 51ST AVE STE 160
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-4622
Country	:	US
Telephone Number	:	623-466-6350
Fax Number	:	602-358-8698

Provider Business Practice Location Address
First Line	:	3035 S ELLSWORTH RD STE 135
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-2162
Country	:	US
Telephone Number	:	623-466-6350
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	AJ SAULNIER
Credential	:
Telephone Number	:	623-295-4916

Provider Enumeration Date	:	01/02/2025
Last Update Date	:	01/02/2025

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