Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 63255 | AZ |
NPI | 1013440544 |
---|---|
Provider Name | Dr. Brent Michael Page |
First Address | Phoenix, AZ 85016-6536 |
Second Address | Phoenix, AZ 85016-6536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2017 |
Last Update Date | 06/07/2021 |