Provider Demographics
NPI:1356388862
Name:HJERMSTAD, BRENT MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:MARTIN
Last Name:HJERMSTAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7370 N OLD CORNFIELD LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-8504
Mailing Address - Country:US
Mailing Address - Phone:509-993-1374
Mailing Address - Fax:928-212-3945
Practice Address - Street 1:7370 N OLD CORNFIELD LN
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-8504
Practice Address - Country:US
Practice Address - Phone:509-993-1374
Practice Address - Fax:928-212-3945
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ10929207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology