Provider Demographics
NPI:1831557321
Name:ARIZONA ALLERGY AND ASTHMA SPECIALISTS P C
Entity type:Organization
Organization Name:ARIZONA ALLERGY AND ASTHMA SPECIALISTS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:MILLHOLLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-705-8844
Mailing Address - Street 1:16611 S 40TH ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0562
Mailing Address - Country:US
Mailing Address - Phone:480-705-8844
Mailing Address - Fax:480-705-8838
Practice Address - Street 1:16611 S 40TH ST
Practice Address - Street 2:SUITE 170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0562
Practice Address - Country:US
Practice Address - Phone:480-705-8844
Practice Address - Fax:480-705-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21604261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ23379Medicare PIN