Healthcare Provider Details

I. General information

NPI: 1790775641
Provider Name (Legal Business Name): JOHN JAMES BRANNAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6480 HARRISON AVE SUITE 100
CINCINNATI OH
45247-7961
US

IV. Provider business mailing address

6480 HARRISON AVE SUITE 201
CINCINNATI OH
45247-7961
US

V. Phone/Fax

Practice location:
  • Phone: 513-354-3700
  • Fax: 513-354-7651
Mailing address:
  • Phone: 513-354-3700
  • Fax: 513-354-7651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number35-06-8376
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number35-06-8376
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: