Healthcare Provider Details

I. General information

NPI: 1912339888
Provider Name (Legal Business Name): BRANDON EMERSON FORBES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 EATON AVE
HAMILTON OH
45013-2767
US

IV. Provider business mailing address

7497 BURTON DR
LIBERTY TOWNSHIP OH
45044-9030
US

V. Phone/Fax

Practice location:
  • Phone: 413-799-1413
  • Fax:
Mailing address:
  • Phone: 419-799-1413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number35.126649
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number57.023307
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.126649
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: