Provider Demographics
NPI:1073522736
Name:LLOYD D BRENDEN MD PC
Entity Type:Organization
Organization Name:LLOYD D BRENDEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-985-9492
Mailing Address - Street 1:7525 E BROADWAY RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-2002
Mailing Address - Country:US
Mailing Address - Phone:480-985-9492
Mailing Address - Fax:480-985-9771
Practice Address - Street 1:7525 E BROADWAY RD
Practice Address - Street 2:SUITE 10
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-2002
Practice Address - Country:US
Practice Address - Phone:480-985-9492
Practice Address - Fax:480-985-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ070002291OtherRAIL ROAD MEDICARE