MEDICARE: BRANDON CONTRERAS

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1962801662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON CONTRERAS

Provider Business Mailing Address
First Line	:	PO BOX 140851
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-0851
Country	:	US
Telephone Number	:	817-726-3118
Fax Number	:

Provider Business Practice Location Address
First Line	:	2122 KIDWELL ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-3913
Country	:	US
Telephone Number	:	817-726-3118
Fax Number	:

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

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	09/19/2014

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Directions to “ BRANDON CONTRERAS ” Practice Location

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