Provider Demographics
NPI:1760660369
Name:BREINHOLT, JOHN P III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:BREINHOLT
Suffix:III
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 1:7505 S MCCLINTOCK DR STE 103
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5042
Mailing Address - Country:US
Mailing Address - Phone:480-755-1000
Mailing Address - Fax:480-755-0011
Practice Address - Street 1:7505 S MCCLINTOCK DR STE 103
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5042
Practice Address - Country:US
Practice Address - Phone:480-755-1000
Practice Address - Fax:480-755-0011
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ22542080P0202X
IN010647462080P0202X
AZ593962080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100104210Medicaid
IN200887980Medicaid
AZ593837Medicaid