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NPI Code Detail

MEDICARE: C. RENEE BRANCH D.O.

MEDICARE: C. RENEE BRANCH D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianL1526TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20078JEOTHERTXBLUE CROSS BLUE SHIELD
3P02097550OTHERTXMCRR
48JK361OTHERTXBCBS

General Provider Information

NPI Number : 1205814753
Entity Type Code : Individual
Provider Name (Legal Business Name) : C. RENEE BRANCH D.O.
Provider Business Mailing Address
First Line : 1910 ROSELAND BLVD
Second Line :
City : TYLER
State : TX
Zip : 75701-4246
Country : US
Telephone Number : 903-533-0644
Fax Number : 903-592-7849
Provider Business Practice Location Address
First Line : 1910 ROSELAND BLVD
Second Line :
City : TYLER
State : TX
Zip : 75701-4246
Country : US
Telephone Number : 903-533-0644
Fax Number : 903-592-7849
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2006
Last Update Date : 03/12/2020

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Directions to “ C. RENEE BRANCH D.O.” Practice Location

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