Healthcare Provider Details

I. General information

NPI: 1093740086
Provider Name (Legal Business Name): BRANDON ISAACSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD
DALLAS TX
75390-7201
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-3437
  • Fax: 214-648-9122
Mailing address:
  • Phone: 214-648-3437
  • Fax: 214-648-9122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberL9258
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberL9258
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberL9258
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: