Provider Demographics
NPI:1720042914
Name:BRACHMAN, DAVID G (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:BRACHMAN
Suffix:
Gender:M
Credentials:MD
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 41700
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-1700
Mailing Address - Country:US
Mailing Address - Phone:602-274-4484
Mailing Address - Fax:602-240-3539
Practice Address - Street 1:350 W THOMAS RD
Practice Address - Street 2:ST JOES RAD/ONC DEPT
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4409
Practice Address - Country:US
Practice Address - Phone:602-406-3170
Practice Address - Fax:602-406-4146
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ238522085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ342387OtherAHCCCS
AZD15963Medicare UPIN
AZ342387OtherAHCCCS