Provider Demographics
NPI:1912152026
Name:MCINTOSH, BRIAN (PAC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9221 E BASELINE RD
Mailing Address - Street 2:SUITE A109-617
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-8310
Mailing Address - Country:US
Mailing Address - Phone:480-357-3904
Mailing Address - Fax:480-357-4639
Practice Address - Street 1:5251 W CAMPBELL AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1715
Practice Address - Country:US
Practice Address - Phone:623-245-0505
Practice Address - Fax:480-357-4639
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4331363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical