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General NPI Number Information
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NPI Number | 1679876353
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Entity Type | Individual
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Provider Name | DANIEL TODD BRANNON D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/17/2010
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Last Update Date | 06/12/2012
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Provider Practice Location Address
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Address Line | 1 MEDICAL VILLAGE DR SUITE 258
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City | EDGEWOOD
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State | KY
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Zip | 41017-3403
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Country | US
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Telephone | 859-301-2211
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Fax |
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Provider Business Mailing Address
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Address Line | 20 MEDICAL VILLAGE DR SUITE 258
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City | EDGEWOOD
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State | KY
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Zip | 41017-5401
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Country | US
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Telephone | 859-301-2211
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 2009018186
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 03376
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License Number State | KY
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