Healthcare Provider Details

I. General information

NPI: 1013282375
Provider Name (Legal Business Name): BRANDON SHAUN ALLPORT ALTILLO MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRANDON SHAUN ALLPORT

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 MONTOPOLIS DR
AUSTIN TX
78741-6411
US

IV. Provider business mailing address

2901 MONTOPOLIS DR
AUSTIN TX
78741-6411
US

V. Phone/Fax

Practice location:
  • Phone: 512-978-9901
  • Fax: 512-901-9765
Mailing address:
  • Phone: 512-978-9901
  • Fax: 512-901-9765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR7644
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD81065
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR7644
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: