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General NPI Number Information
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NPI Number | 1689678674
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Entity Type | Individual
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Provider Name | JACK W BRAND JR. MD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 1720A MEDICAL PARK DR SUITE 340
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City | BILOXI
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State | MS
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Zip | 39532-2129
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Country | US
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Telephone | 228-392-7429
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Fax | 228-396-3830
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Provider Business Mailing Address
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Address Line | 1720A MEDICAL PARK DR SUITE 340
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City | BILOXI
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State | MS
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Zip | 39532-2129
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Country | US
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Telephone | 228-392-7429
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Fax | 228-396-3830
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 11555
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 10246
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License Number State | MS
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