Provider Demographics
NPI:1831621051
Name:ALYAS, BRANDON (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:ALYAS
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 1:6621 W ROWEL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-1062
Mailing Address - Country:US
Mailing Address - Phone:623-570-3807
Mailing Address - Fax:
Practice Address - Street 1:7801 E BUSH LAKE RD STE 400
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55439-3113
Practice Address - Country:US
Practice Address - Phone:623-570-3807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD01922311207Q00000X
MN68953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine