Provider Demographics
NPI:1114509544
Name:BRICKNER, EVAN DREW (MD)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:DREW
Last Name:BRICKNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5210 E FARNESS DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2140
Mailing Address - Country:US
Mailing Address - Phone:520-795-4100
Mailing Address - Fax:520-795-4224
Practice Address - Street 1:5210 E FARNESS DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2140
Practice Address - Country:US
Practice Address - Phone:520-795-4100
Practice Address - Fax:520-795-4224
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ72573207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR78562OtherARIZONA MEDICAL BOARD