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General NPI Number Information
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NPI Number | 1386099851
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Entity Type | Individual
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Provider Name | BRANDON CLIFFORD NG M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 2165 WHITE BEAR AVE N
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City | MAPLEWOOD
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State | MN
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Zip | 55109-2707
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Country | US
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Telephone | 651-523-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 2025 SLOAN PL STE 35
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City | SAINT PAUL
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State | MN
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Zip | 55117-2092
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Country | US
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Telephone | 651-772-1572
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Fax | 651-772-1889
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 62755
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License Number State | MN
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