MEDICARE: BRANDON MEDICAL, LLC

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	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073511184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANDON MEDICAL, LLC

Provider Business Mailing Address
First Line	:	PO BOX 684
Second Line	:
City	:	FORT GIBSON
State	:	OK
Zip	:	74434-0684
Country	:	US
Telephone Number	:	918-478-2845
Fax Number	:	918-478-5519

Provider Business Practice Location Address
First Line	:	110 NORTH LEE STREET
Second Line	:
City	:	FORT GIBSON
State	:	OK
Zip	:	74434
Country	:	US
Telephone Number	:	918-478-2845
Fax Number	:	918-478-5519

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN M BRANDON
Credential	:
Telephone Number	:	918-478-2845

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	09/30/2008

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Directions to “BRANDON MEDICAL, LLC ” Practice Location

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