Provider Demographics
NPI:1821758590
Name:RANDY BRAZIE MD PLLC
Entity Type:Organization
Organization Name:RANDY BRAZIE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-387-5187
Mailing Address - Street 1:2375 E CAMELBACK RD STE 600
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3493
Mailing Address - Country:US
Mailing Address - Phone:602-387-5185
Mailing Address - Fax:602-584-6136
Practice Address - Street 1:2375 E CAMELBACK RD STE 600
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3493
Practice Address - Country:US
Practice Address - Phone:602-387-5185
Practice Address - Fax:602-584-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)