Provider Demographics
NPI:1508325697
Name:MCBRIDE, MICHAEL OWEN (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:OWEN
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61025
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-1025
Mailing Address - Country:US
Mailing Address - Phone:480-681-3300
Mailing Address - Fax:480-681-3301
Practice Address - Street 1:4425 E AGAVE RD STE 148
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-0623
Practice Address - Country:US
Practice Address - Phone:480-704-7546
Practice Address - Fax:480-704-7549
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ010270207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program