Healthcare Provider Details

I. General information

NPI: 1114992070
Provider Name (Legal Business Name): JOHN E BRANDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27340 HIGHWAY 86
GORDO AL
35466
US

IV. Provider business mailing address

27340 HIGHWAY 86
GORDO AL
35466
US

V. Phone/Fax

Practice location:
  • Phone: 205-364-7135
  • Fax: 205-364-8244
Mailing address:
  • Phone: 205-364-7135
  • Fax: 205-364-8244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8876
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: