MEDICARE: DR. KEITH EDWARD BRANDT MD, MPH

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	2083A0100X	Aerospace Medicine Physician	Q9583	TX
2	2083A0100X	Aerospace Medicine Physician	01040212A	IN
3	207Q00000X	Family Medicine Physician	Q9583	TX

General Provider Information

NPI Number	:	1801875612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH EDWARD BRANDT MD, MPH

Provider Business Mailing Address
First Line	:	PO BOX 650859
Second Line	:	DEPT 710
City	:	DALLAS
State	:	TX
Zip	:	75265-2100
Country	:	US
Telephone Number	:	409-747-6240
Fax Number	:

Provider Business Practice Location Address
First Line	:	2240 GULF FWY S
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-5143
Country	:	US
Telephone Number	:	409-772-2222
Fax Number	:

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	12/12/2022

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