Individual provider · NPI-1

Brandon Eugene Fornwalt

Otolaryngology · Glendale, AZ

NPI number1912407172
StatusActive
Last updated in NPPESJul 3, 2023

Details

NPI
1912407172
Entity type
Individual (NPI-1)
Name
Brandon Eugene Fornwalt
Sex
Male
Sole proprietor
No
Enumeration date
Feb 14, 2018
Certification date
Jul 3, 2023
Last updated
Jul 3, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Y00000X Otolaryngology009926AZYes

Practice location

18699 N 67th Ave Ste 300
Glendale, AZ 85308-7149

Phone 623-566-4718 · Fax 523-566-4820

Mailing address

9097 E Desert Cove Ave Ste 200
Scottsdale, AZ 85260-6280

Phone 928-614-7516 · Fax 480-214-9929

Other practice locations

9250 W Thomas Rd Ste 350
Phoenix, AZ 85037-3385

Phone 623-848-8890 · Fax 623-848-7848

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