Healthcare Provider Details

I. General information

NPI: 1417967753
Provider Name (Legal Business Name): BRANDY BROMAGEN FOUCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 COMMERCE CIR
MT STERLING KY
40353-7815
US

IV. Provider business mailing address

PO BOX 1347
MT STERLING KY
40353-5347
US

V. Phone/Fax

Practice location:
  • Phone: 859-498-5243
  • Fax: 859-498-5396
Mailing address:
  • Phone: 859-498-5243
  • Fax: 859-498-5396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39940
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: