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NPI Code Detail

MEDICARE: DR. CHARLES WESLEY BRANSFORD MD

MEDICARE: DR. CHARLES WESLEY BRANSFORD MD
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
1207R00000XInternal Medicine Physician25254MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568448538
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES WESLEY BRANSFORD MD
Provider Business Mailing Address
First Line : 8170 33RD AVE S # MS 21110Q
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55425-4516
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 921 GREELEY ST S
Second Line :
City : STILLWATER
State : MN
Zip : 55082-5935
Country : US
Telephone Number : 651-439-1234
Fax Number : 651-439-1928
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2005
Last Update Date : 03/10/2021

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Directions to “ DR. CHARLES WESLEY BRANSFORD MD” Practice Location

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