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NPI Code Detail

MEDICARE: DR. BRANDON D KETRON DO

MEDICARE: DR. BRANDON D KETRON DO
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
1207R00000XInternal Medicine Physician0102204175VA
2207R00000XInternal Medicine Physician2765TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558629907
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRANDON D KETRON DO
Provider Business Mailing Address
First Line : PO BOX 632476
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-2476
Country : US
Telephone Number : 423-794-5520
Fax Number : 423-282-6940
Provider Business Practice Location Address
First Line : 301 MED TECH PKWY
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-2630
Country : US
Telephone Number : 423-794-5520
Fax Number : 423-282-6940
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2012
Last Update Date : 02/19/2025

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