Provider Demographics
NPI:1841291804
Name:ABEYTA, BRANDON JUDE (MD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:JUDE
Last Name:ABEYTA
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 1:645 E MISSOURI AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1351
Mailing Address - Country:US
Mailing Address - Phone:602-262-8900
Mailing Address - Fax:602-262-8890
Practice Address - Street 1:3390 N CAMPBELL AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2380
Practice Address - Country:US
Practice Address - Phone:520-795-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9049207L00000X
NM2003-0436207L00000X
AZ51249207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM202013736OtherPHP
TX168654501Medicaid
TXH0134723OtherDPS
TXH0134723OtherDPS
TX8C6856Medicare ID - Type Unspecified
TX168654501Medicaid