Individual
BRENT L MADSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
914 N SCOTTSDALE RD STE 104, TEMPE, AZ 85288-2116
(480) 924-8382
(480) 966-0566
Mailing address
120 PARK AVE, HEBRON, NE 68370-2019
(402) 768-7203
(402) 768-4669
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
631
NE
363A00000X
Physician Assistant
5119
OK
363A00000X
Physician Assistant
Primary
631
NE
363A00000X
Physician Assistant
9900
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
508944155
—
NE
Enumeration date
11/10/2005
Last updated
05/05/2025
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