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General NPI Number Information
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NPI Number | 1013282375
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Entity Type | Individual
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Provider Name | BRANDON SHAUN ALLPORT ALTILLO MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 03/19/2012
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Last Update Date | 05/17/2024
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Provider Practice Location Address
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Address Line | 2901 MONTOPOLIS DR
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City | AUSTIN
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State | TX
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Zip | 78741-6411
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Country | US
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Telephone | 512-978-9901
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Fax | 512-901-9765
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Provider Business Mailing Address
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Address Line | 2901 MONTOPOLIS DR
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City | AUSTIN
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State | TX
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Zip | 78741-6411
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Country | US
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Telephone | 512-978-9901
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Fax | 512-901-9765
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | R7644
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | D81065
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R7644
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License Number State | TX
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