Basic Information
| Provider Information | |||||||||
| NPI: | 1437186335 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELISIO | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4838 E BASELINE RD STE 108 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852064672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809812400 | ||||||||
| FaxNumber: | 4809812407 | ||||||||
| Practice Location | |||||||||
| Address1: | 4838 E BASELINE RD STE 108 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809812400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LA0401X | 33634 | AZ | N | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine | 207L00000X | 33634 | AZ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 945131 | 05 | AZ | MEDICAID | P00402237 | 01 | AZ | RAILROAD MEDICARE | OTHER |