Organization
FLAGSTAFF NEUROSURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRADLEY ROBERT NICOL MD (OWNER)
(928) 226-7667
Entity
Organization
Contact information
Practice address
823 N SAN FRANCISCO ST, SUITE F, FLAGSTAFF, AZ 86001
(928) 226-7667
(928) 226-7664
Mailing address
823 N SAN FRANCISCO ST, SUITE F, FLAGSTAFF, AZ 86001
(928) 226-7667
(928) 226-7664
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
30127
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
701690
—
AZ
Enumeration date
01/04/2013
Last updated
06/28/2023
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