Healthcare Provider Details

I. General information

NPI: 1730526351
Provider Name (Legal Business Name): BRANDON J ALEXANDER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 W COLUMBIA ST
ORLANDO FL
32806
US

IV. Provider business mailing address

83 W COLUMBIA ST
ORLANDO FL
32806
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-3220
  • Fax: 321-843-3210
Mailing address:
  • Phone: 321-843-3220
  • Fax: 321-843-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS13952
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberUO3549
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: