IndividualActive
Brandon Fornwalt
NPI 1912407172 · Otolaryngology Physician · Glendale, AZ
Provider details
- NPI number
- 1912407172
- Entity type
- Individual
- Primary specialty
- Otolaryngology PhysicianAllopathic & Osteopathic Physicians
- Sex
- Male
- Sole proprietor
- No
- License
- 009926 (AZ)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
18699 N 67th Ave Ste 300
Glendale, AZ 85308-7149
Phone: (623) 566-4718
Fax: (523) 566-4820
Approximate (ZIP-level) locationGet directions
Mailing address
9097 E Desert Cove Ave Ste 200
Scottsdale, AZ 85260-6280
Additional practice locations (1)
- 9250 W Thomas Rd Ste 350Phoenix, AZ 85037-3385Phone: (623) 848-8890Fax: (623) 848-7848
Registry dates
- Enumerated
- 2018-02-14
- Last updated
- 2023-07-03
- Certified
- 2023-07-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.