MEDICARE: DR. BRANDON MICAH BREVIG D.O.

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	208100000X	Physical Medicine & Rehabilitation Physician	11-6037195	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11-6037195	OTHER	NY	GERALD TEPLITZ, DO

General Provider Information

NPI Number	:	1306057641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON MICAH BREVIG D.O.

Provider Business Mailing Address
First Line	:	2032 E SIDEWINDER DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-5867
Country	:	US
Telephone Number	:	208-488-8408
Fax Number	:	888-913-3862

Provider Business Practice Location Address
First Line	:	302 W IDAHO ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-6039
Country	:	US
Telephone Number	:	208-994-4962
Fax Number	:	888-913-3862

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	01/06/2016

Similar Medicare Providers

1427443613 — SPARKMD
Practice Location Address:

302 W IDAHO ST
BOISE, ID
83702-6039

Practice Phone: 208-369-4590
Practice Fax:

1114940699 — DR. JAMES M JOHNSTON MD
Practice Location Address:

703 S AMERICANA BLVD , STE 120
BOISE, ID
83702-5099

Practice Phone: 208-323-2600
Practice Fax: 208-323-9172

1194314294 — CARA RUIZ LCPC
Practice Location Address:

1276 W RIVER ST STE 100
BOISE, ID
83702-7083

Practice Phone: 208-338-4699
Practice Fax:

1275145047 — LEAH MULDOON NP
Practice Location Address:

425 W BANNOCK ST
BOISE, ID
83702-6035

Practice Phone: 208-343-6458
Practice Fax:

1285425520 — DR. JO-ELLEN WATSON PH.D. , LICSW
Practice Location Address:

505 S ASH ST APT 120
BOISE, ID
83702-6938

Practice Phone: 206-715-2733
Practice Fax:

1861995979 — JANESSA LYNETTE LAZAR
Practice Location Address:

1404 W IDAHO ST
BOISE, ID
83702-5002

Practice Phone: 208-968-7470
Practice Fax:

Directions to “ DR. BRANDON MICAH BREVIG D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.