Provider Demographics
NPI:1720067390
Name:RIZZO, BRIAN SCOTT (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SCOTT
Last Name:RIZZO
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 1:24220 N 62ND DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-2734
Mailing Address - Country:US
Mailing Address - Phone:623-572-5019
Mailing Address - Fax:
Practice Address - Street 1:16841 N 31ST AVE BLDG 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-3029
Practice Address - Country:US
Practice Address - Phone:602-843-4844
Practice Address - Fax:602-843-4846
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ3597207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG12633Medicare UPIN