Provider Demographics
NPI:1083111603
Name:ARIZONA ALLERGY AND ASTHMA SPECIALISTS PC
Entity Type:Organization
Organization Name:ARIZONA ALLERGY AND ASTHMA SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:MILLHOLLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-705-8844
Mailing Address - Street 1:16611 S 40TH ST STE 170
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0565
Mailing Address - Country:US
Mailing Address - Phone:480-705-8844
Mailing Address - Fax:480-705-8838
Practice Address - Street 1:16611 S 40TH ST STE 170
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0565
Practice Address - Country:US
Practice Address - Phone:480-705-8844
Practice Address - Fax:480-705-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21604207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty