Provider Demographics
NPI:1740493428
Name:BRAZIE, RANDY (MD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:BRAZIE
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 1:2255 W NORTHERN AVE STE B100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4936
Mailing Address - Country:US
Mailing Address - Phone:602-995-1767
Mailing Address - Fax:602-995-1863
Practice Address - Street 1:2255 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4936
Practice Address - Country:US
Practice Address - Phone:602-995-1767
Practice Address - Fax:602-995-1863
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ352612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ379950Medicaid
AZ379950Medicaid
AZ379950Medicaid