MEDICARE: BRANDON TYLER PERSONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347E00000X	Transportation Broker	TF228950	OH

General Provider Information

NPI Number	:	1053096230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON TYLER PERSONS

Provider Business Mailing Address
First Line	:	5380 E 132ND ST
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-3206
Country	:	US
Telephone Number	:	216-633-9833
Fax Number	:

Provider Business Practice Location Address
First Line	:	5380 E 132ND ST
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-3206
Country	:	US
Telephone Number	:	216-633-9833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2023
Last Update Date	:	06/16/2023

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Directions to “ BRANDON TYLER PERSONS ” Practice Location

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