MEDICARE: RANDY BRAZIE M.D.

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	2084P0800X	Psychiatry Physician	35261	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740493428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY BRAZIE M.D.

Provider Business Mailing Address
First Line	:	2255 W NORTHERN AVE STE B100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4936
Country	:	US
Telephone Number	:	602-995-1767
Fax Number	:	602-995-1863

Provider Business Practice Location Address
First Line	:	2255 W NORTHERN AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4936
Country	:	US
Telephone Number	:	602-995-1767
Fax Number	:	602-995-1863

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	10/22/2021

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