Healthcare Provider Details

I. General information

NPI: 1811070006
Provider Name (Legal Business Name): DANIEL J BRANDT M.D., P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 N MESILLA ST
LAS CRUCES NM
88005-2566
US

IV. Provider business mailing address

424 N MESILLA ST
LAS CRUCES NM
88005-2566
US

V. Phone/Fax

Practice location:
  • Phone: 505-525-8250
  • Fax: 505-647-2543
Mailing address:
  • Phone: 505-525-8250
  • Fax: 505-647-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberNM91-10
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: