Healthcare Provider Details

I. General information

NPI: 1063643401
Provider Name (Legal Business Name): BRANDON R. MCNEW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 DUFF AVENUE
AMES IA
50010-3014
US

IV. Provider business mailing address

1215 DUFF AVENUE
AMES IA
50010-3014
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-4404
  • Fax: 515-239-4721
Mailing address:
  • Phone: 515-239-4404
  • Fax: 515-239-4721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301094362
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-40357
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40357
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: