MEDICARE: BRANDON DELAVAR

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
1	207P00000X	Emergency Medicine Physician	MD.41827	AL
2	207P00000X	Emergency Medicine Physician	T5294	TX

General Provider Information

NPI Number	:	1427510999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON DELAVAR

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 S 31ST ST
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76508-1900
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	05/12/2023

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Directions to “ BRANDON DELAVAR ” Practice Location

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