Individual
BRANDON EUGENE FORNWALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18699 N 67TH AVE STE 300, GLENDALE, AZ 85308-7149
(623) 566-4718
(523) 566-4820
Mailing address
9097 E DESERT COVE AVE STE 200, SCOTTSDALE, AZ 85260-6280
(928) 614-7516
(480) 214-9929
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
009926
AZ
Other
Enumeration date
02/14/2018
Last updated
07/03/2023
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