Provider Demographics
NPI:1992752463
Name:LABBAN, BRENDON J (DO)
Entity type:Individual
Prefix:
First Name:BRENDON
Middle Name:J
Last Name:LABBAN
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5751 N 24TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-2831
Mailing Address - Country:US
Mailing Address - Phone:480-639-9953
Mailing Address - Fax:
Practice Address - Street 1:7242 E OSBORN RD STE 300
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6494
Practice Address - Country:US
Practice Address - Phone:480-639-9953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2717207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ124157Medicaid
AZAZ0711520OtherBCBS PROV NUMBER
AZZ68666Medicare PIN
AZF50380Medicare UPIN
AZ124157Medicaid