Provider Demographics
NPI:1023327251
Name:BRAZEL, PERRY A (PA-C)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:A
Last Name:BRAZEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PERRY
Other - Middle Name:A
Other - Last Name:NUSSBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3815 E BELL RD STE 2100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2134
Mailing Address - Country:US
Mailing Address - Phone:602-726-8805
Mailing Address - Fax:602-944-4147
Practice Address - Street 1:3815 E BELL RD STE 2100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2134
Practice Address - Country:US
Practice Address - Phone:602-726-8805
Practice Address - Fax:602-944-4147
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4744363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ585848Medicaid