Healthcare Provider Details

I. General information

NPI: 1538147061
Provider Name (Legal Business Name): JAMES DAVID BRANCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 TOWN RUN LN
WINSTON-SALEM NC
27101-3911
US

IV. Provider business mailing address

224 TOWN RUN LN
WINSTON-SALEM NC
27101-3911
US

V. Phone/Fax

Practice location:
  • Phone: 336-723-0748
  • Fax: 336-721-4711
Mailing address:
  • Phone: 336-723-0748
  • Fax: 336-721-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberNC21915
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: