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NPI Code Detail

MEDICARE: GREGORY BRANSTETTER CST,CFA,KCSA

MEDICARE: GREGORY BRANSTETTER CST,CFA,KCSA
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
1363AS0400XSurgical Physician Assistant82418KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100F817OTHERKYCERTIFIED FIRST ASSISTANT

General Provider Information

NPI Number : 1083769681
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY BRANSTETTER CST,CFA,KCSA
Provider Business Mailing Address
First Line : 106 COLUMNS PLAZA DR
Second Line :
City : GLASGOW
State : KY
Zip : 42141-8068
Country : US
Telephone Number : 270-651-9390
Fax Number : 270-651-8698
Provider Business Practice Location Address
First Line : 106 COLUMNS PLAZA DR
Second Line :
City : GLASGOW
State : KY
Zip : 42141-8068
Country : US
Telephone Number : 270-651-9390
Fax Number : 270-651-8698
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 07/08/2007

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