Provider Demographics
NPI:1245219336
Name:PAGE, BRIAN S (DO)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:S
Last Name:PAGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20325 N. 51ST AVE.
Mailing Address - Street 2:BLD 8 SUITE 160
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4622
Mailing Address - Country:US
Mailing Address - Phone:623-466-6350
Mailing Address - Fax:602-358-8698
Practice Address - Street 1:20325 N. 51ST AVE
Practice Address - Street 2:BLD 8 SUITE 160
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-4622
Practice Address - Country:US
Practice Address - Phone:623-466-6350
Practice Address - Fax:602-358-8698
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3416207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ461658Medicaid
AZ27396Medicare ID - Type Unspecified
AZ461658Medicaid