Provider Demographics
NPI:1861454530
Name:LAYTON, BRENT J (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:J
Last Name:LAYTON
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 2260
Mailing Address - Street 2:
Mailing Address - City:CLAYPOOL
Mailing Address - State:AZ
Mailing Address - Zip Code:85532-2260
Mailing Address - Country:US
Mailing Address - Phone:928-402-0096
Mailing Address - Fax:928-402-0098
Practice Address - Street 1:5884 S HOSPITAL DRIVE
Practice Address - Street 2:SUITE #1
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501
Practice Address - Country:US
Practice Address - Phone:928-402-0096
Practice Address - Fax:928-402-0098
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0383440OtherBLUE CROSS BLUE SHIELD
1423714OtherBANNER
18053338OtherSTATE FUND INDUSTRIAL
22440405OtherUNITED HEALTH CARE
AZZMD14119AOtherMEDICARE GROUP ID
1005627OtherCIGNA
1Z9109OtherHEALTH NET
AZ248395Medicaid
AZZMD14119AOtherMEDICARE GROUP ID
AZZ119597Medicare PIN