Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Brandon Eugene Fornwalt

Individual provider Otolaryngology Physician · NPI 1912407172

Brandon Eugene Fornwalt is an Otolaryngology in Glendale, Arizona. Graduated from Arizona College of Osteopathic Medicine Mid Western University in 2018, 8 years ago. Practices with Valley ENT PC, a 69-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
8
Trained at
Arizona College of Osteopathic Medicine Mid Western University
Licensed in
AZ
In the registry since
2018
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Practice location Address checks out

18699 N 67th Ave Ste 300
Glendale, AZ 85308-7149
Phone: (623) 566-4718
Fax: (523) 566-4820
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 9250 W Thomas Rd Ste 350, Phoenix, AZ 85037-3385 — (623) 848-8890

Specialties & licences

Otolaryngology Physician (primary) Taxonomy 207Y00000X · Licence 009926 (AZ)

Record details

NPI number1912407172
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedFebruary 14, 2018
Last updated in NPPESJuly 3, 2023
Certification dateJuly 3, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOTOLARYNGOLOGY
Medical schoolARIZONA COLLEGE OF OSTEOPATHIC MEDICINE MID WESTERN UNIVERSITY
Graduated 2018 (8 years in practice)
Group practice Valley Ent Pc — 69 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Glendale