Healthcare Provider Details

I. General information

NPI: 1316674666
Provider Name (Legal Business Name): BRANDON ERIC BARTON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR
SAN ANTONIO TX
78234-4504
US

IV. Provider business mailing address

3551 ROGER BROOKE DR
JBSA FT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-0439
  • Fax:
Mailing address:
  • Phone: 210-916-1925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: