Provider Demographics
NPI:1285854562
Name:MISCALL, BRIAN GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:GEORGE
Last Name:MISCALL
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:8100 WYOMING BLVD NE
Mailing Address - Street 2:M-4 #285
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1963
Mailing Address - Country:US
Mailing Address - Phone:505-299-0836
Mailing Address - Fax:
Practice Address - Street 1:6501 SAN ANTONIO DR NE
Practice Address - Street 2:#803
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4139
Practice Address - Country:US
Practice Address - Phone:505-299-0836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM77-223208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery