Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | AZ3597 | AZ |
NPI | 1720067390 |
---|---|
Provider Name | Dr. Brian Scott Rizzo |
First Address | Glendale, AZ 85310-2734 |
Second Address | Phoenix, AZ 85053-3029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 30/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G12633 | (02) | AZ |