Healthcare Provider Details

I. General information

NPI: 1801875612
Provider Name (Legal Business Name): KEITH EDWARD BRANDT MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 GULF FWY S
LEAGUE CITY TX
77573-5143
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-2100
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-2222
  • Fax:
Mailing address:
  • Phone: 409-747-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberQ9583
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number01040212A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ9583
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: