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General NPI Number Information
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NPI Number | 1386640076
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Entity Type | Individual
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Provider Name | GENE D BRANUM MD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 180 1ST ST W #301
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City | KETCHUM
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State | ID
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Zip | 83340
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Country | US
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Telephone | 208-726-3707
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3778
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City | KETCHUM
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State | ID
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Zip | 83340-3721
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Country | US
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Telephone | 208-726-3707
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Fax | 208-726-4817
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101230423
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M-13897
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License Number State | ID
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