Provider Demographics
NPI:1801953484
Name:BRACHFELD, MARK I (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:I
Last Name:BRACHFELD
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 1:2034 E SOUTHERN AVE
Mailing Address - Street 2:SUITE Y
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7522
Mailing Address - Country:US
Mailing Address - Phone:480-838-7466
Mailing Address - Fax:480-820-0983
Practice Address - Street 1:2034 E SOUTHERN AVE
Practice Address - Street 2:SUITE Y
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7522
Practice Address - Country:US
Practice Address - Phone:480-838-7466
Practice Address - Fax:480-820-0983
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD36585Medicare UPIN
AZ61020Medicare ID - Type Unspecified