Provider Demographics
NPI:1700850492
Name:NORTH PHOENIX INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:NORTH PHOENIX INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:BRUBAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-589-0370
Mailing Address - Street 1:1747 E MORTEN AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4602
Mailing Address - Country:US
Mailing Address - Phone:602-589-0370
Mailing Address - Fax:602-589-0650
Practice Address - Street 1:1747 E MORTEN AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4602
Practice Address - Country:US
Practice Address - Phone:602-589-0370
Practice Address - Fax:602-589-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14717261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWDBRDMedicare ID - Type Unspecified
AZD36612Medicare UPIN