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NPI Code Detail

MEDICARE: LAURIE L BRANDON MD

MEDICARE: LAURIE L BRANDON 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
1207L00000XAnesthesiology Physician01053924IN

General Provider Information

NPI Number : 1710977335
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURIE L BRANDON MD
Provider Business Mailing Address
First Line : PO BOX 633260
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-3260
Country : US
Telephone Number : 317-802-6303
Fax Number : 317-870-0499
Provider Business Practice Location Address
First Line : 5734 COVENTRY LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7141
Country : US
Telephone Number : 260-436-7875
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2005
Last Update Date : 10/29/2007

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