Provider Demographics
NPI:1245407428
Name:ARLO B BRAKEL MD LLC
Entity Type:Organization
Organization Name:ARLO B BRAKEL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ARLO
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:BRAKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-749-3509
Mailing Address - Street 1:PO BOX 30575
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-0575
Mailing Address - Country:US
Mailing Address - Phone:520-749-3509
Mailing Address - Fax:520-749-3323
Practice Address - Street 1:450 W CONTINENTAL RD STE B
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85622-3551
Practice Address - Country:US
Practice Address - Phone:520-749-3509
Practice Address - Fax:520-749-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32307207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty