Healthcare Provider Details

I. General information

NPI: 1225025380
Provider Name (Legal Business Name): ALFRED HERBERT BRANDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6030 HOLLYWOOD BLVD SUITE 100
HOLLYWOOD FL
33024-7964
US

IV. Provider business mailing address

2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 954-322-7200
  • Fax: 954-322-7203
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME 41813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: