MEDICARE: DR. BRIAN GEORGE MISCALL 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	208600000X	Surgery Physician	77-223	NM

General Provider Information

NPI Number	:	1285854562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN GEORGE MISCALL MD

Provider Business Mailing Address
First Line	:	8100 WYOMING BLVD NE
Second Line	:	M-4 #285
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-1963
Country	:	US
Telephone Number	:	505-299-0836
Fax Number	:

Provider Business Practice Location Address
First Line	:	6501 SAN ANTONIO DR NE
Second Line	:	#803
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4139
Country	:	US
Telephone Number	:	505-299-0836
Fax Number	:

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

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	07/08/2007

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