MEDICARE: BRANDON S ATKINSON 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
1	207Q00000X	Family Medicine Physician	20A7613	CA
2	207Q00000X	Family Medicine Physician	N1538	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1619979614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON S ATKINSON D.O.

Provider Business Mailing Address
First Line	:	12465 TIMBERLAND BLVD STE 401
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5215
Country	:	US
Telephone Number	:	817-741-8355
Fax Number	:	817-741-8365

Provider Business Practice Location Address
First Line	:	12465 TIMBERLAND BLVD STE 401
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5215
Country	:	US
Telephone Number	:	817-741-8355
Fax Number	:	817-741-8365

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	08/05/2011

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