Individual
JAN H BREKKE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5322 W NORTHERN AVE, GLENDALE, AZ 85301-1405
(480) 425-5063
(623) 915-6924
Mailing address
5322 W NORTHERN AVE, GLENDALE, AZ 85301-1405
(480) 425-5063
(623) 915-6924
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
27440
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28532
VRL
AZ
01
—
476079
AHCCCS
AZ
Enumeration date
10/20/2005
Last updated
07/08/2007
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