Healthcare Provider Details

I. General information

NPI: 1801190731
Provider Name (Legal Business Name): DENIS F BRANSON MD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 E GENESEE ST BUILDING E
FAYETTEVILLE NY
13066-1131
US

IV. Provider business mailing address

7000 E GENESEE ST BUILDING E
FAYETTEVILLE NY
13066-1131
US

V. Phone/Fax

Practice location:
  • Phone: 315-446-8313
  • Fax: 315-446-5387
Mailing address:
  • Phone: 315-446-8313
  • Fax: 315-446-5387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number162343
License Number StateNY

VIII. Authorized Official

Name: DR. DENIS F BRANSON
Title or Position: PRESIDENT
Credential: MD
Phone: 315-446-8313