Healthcare Provider Details

I. General information

NPI: 1700977170
Provider Name (Legal Business Name): ANTHONY J BRANZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E MULLAN AVENUE
OSBURN ID
83849-0707
US

IV. Provider business mailing address

PO BOX 707
OSBURN ID
83849-0707
US

V. Phone/Fax

Practice location:
  • Phone: 208-556-4803
  • Fax: 208-556-1023
Mailing address:
  • Phone: 208-556-4803
  • Fax: 208-556-1023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-6860
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: