Provider Demographics
NPI:1457575813
Name:BRIZENDINE, JOHN BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRIAN
Last Name:BRIZENDINE
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 1:20333 N 19TH AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-9901
Mailing Address - Country:US
Mailing Address - Phone:480-707-9504
Mailing Address - Fax:602-581-7764
Practice Address - Street 1:20333 N 19TH AVE STE 230
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-9901
Practice Address - Country:US
Practice Address - Phone:480-707-9504
Practice Address - Fax:602-581-7764
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL 25038208600000X
MO2008033381208600000X
AZ61144208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1457575813Medicaid
E29000002Medicare PIN