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General NPI Number Information
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NPI Number | 1437206885
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Entity Type | Organization
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Legal Business Name | STEPHEN R BRANDT MD GROUP
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 105 E WATTS ST
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City | ENTERPRISE
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State | AL
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Zip | 36330-2511
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Country | US
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Telephone | 334-393-5437
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Fax | 334-393-4185
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Provider Business Mailing Address
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Address Line | 633 S UNION AVE
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City | OZARK
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State | AL
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Zip | 36360-1836
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Country | US
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Telephone | 334-774-1412
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Fax | 334-774-1825
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN RAYMOND BRANDT
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Credential | MD
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Telephone | 334-774-1412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 16264
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License Number State | AL
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