Healthcare Provider Details

I. General information

NPI: 1235126186
Provider Name (Legal Business Name): PAUL ANDERSON BRANNAN MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 CLARK RD STE 106
SARASOTA FL
34233-3228
US

IV. Provider business mailing address

5310 CLARK RD STE 106
SARASOTA FL
34233-3228
US

V. Phone/Fax

Practice location:
  • Phone: 941-921-0400
  • Fax:
Mailing address:
  • Phone: 941-921-0400
  • Fax: 941-870-1628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35076811
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME102185
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME102185
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: