Provider Demographics
NPI:1962624056
Name:ARIZONA GENERAL SURGERY SPECIALIST PC
Entity type:Organization
Organization Name:ARIZONA GENERAL SURGERY SPECIALIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PREBIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-486-7700
Mailing Address - Street 1:14155 N 83RD AVE STE A-105
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5639
Mailing Address - Country:US
Mailing Address - Phone:623-486-7700
Mailing Address - Fax:623-486-7703
Practice Address - Street 1:14155 N 83RD AVE STE A-105
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5639
Practice Address - Country:US
Practice Address - Phone:209-956-7725
Practice Address - Fax:623-486-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174400000X
208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ104293Medicare ID - Type Unspecified