MEDICARE: DR. BRANDON CLINT MD

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	207R00000X	Internal Medicine Physician	J1934	TX
2	2083A0100X	Aerospace Medicine Physician	J1934	TX

General Provider Information

NPI Number	:	1144214677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON CLINT MD

Provider Business Mailing Address
First Line	:	377 TH MEDICAL GROUP
Second Line	:	2050A SECOND STREET SE
City	:	KIRTLAND AFB
State	:	NM
Zip	:	87117-5522
Country	:	US
Telephone Number	:	505-846-2193
Fax Number	:

Provider Business Practice Location Address
First Line	:	377 TH MEDICAL GROUP
Second Line	:	2050A SECOND STREET SE
City	:	KIRTLAND AFB
State	:	NM
Zip	:	87117-5522
Country	:	US
Telephone Number	:	505-846-2193
Fax Number	:

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	09/26/2013

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