Provider Demographics
NPI:1700882651
Name:PEART, BRENDA C (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:C
Last Name:PEART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 E SPEEDWAY BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3928
Mailing Address - Country:US
Mailing Address - Phone:520-886-3432
Mailing Address - Fax:520-886-0169
Practice Address - Street 1:6567 E CARONDELET DR
Practice Address - Street 2:SUITE 225
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6152
Practice Address - Country:US
Practice Address - Phone:520-886-3432
Practice Address - Fax:520-886-0169
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16682174400000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ291790Medicaid
AZP00958363OtherRR MEDICARE
AZ291790Medicaid
AZ116020Medicare PIN
AZP00958363OtherRR MEDICARE
AZ144896Medicare PIN
AZ115613Medicare PIN