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General NPI Number Information
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NPI Number | 1982067344
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Entity Type | Individual
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Provider Name | ERIC ALAN BRANCH MD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2016
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 2011 HARRISON AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4545
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Country | US
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Telephone | 850-691-4188
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Fax |
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Provider Business Mailing Address
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Address Line | 3334 CAPITAL MEDICAL BLVD STE 400
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4470
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Country | US
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Telephone | 850-877-8174
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Fax | 850-656-5408
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | ME151012
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License Number State | FL
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