Provider Demographics
NPI:1639132087
Name:PREBIL, BRIAN EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EDWARD
Last Name:PREBIL
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 1:14155 N 83RD AVE
Mailing Address - Street 2:STE. A-105
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5639
Mailing Address - Country:US
Mailing Address - Phone:623-486-7700
Mailing Address - Fax:623-486-7704
Practice Address - Street 1:14155 N. 83RD AVE.,
Practice Address - Street 2:STE. A-105
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:623-486-7700
Practice Address - Fax:623-486-7704
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3772208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0772130OtherBLUE CROSS BLUE SHIELD ID
AZ796287Medicaid
AZAZ0772130OtherBLUE CROSS BLUE SHIELD ID
AZZ104294Medicare ID - Type UnspecifiedMEDICARE ID #