Healthcare Provider Details

I. General information

NPI: 1417516253
Provider Name (Legal Business Name): BRANDON JACKSON PAINTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 02/02/2025
Certification Date: 02/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GREENLEY RD
SONORA CA
95370-5200
US

IV. Provider business mailing address

1000 GREENLEY RD
SONORA CA
95370-5200
US

V. Phone/Fax

Practice location:
  • Phone: 209-536-5750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA180745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: