MEDICARE: BRANNON OBSTETRICS & GYNECOLOGY, P.A.

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	207V00000X	Obstetrics & Gynecology Physician	76155	NC

Other Identifiers

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

General Provider Information

NPI Number	:	1992884068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANNON OBSTETRICS & GYNECOLOGY, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 843332
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02284-3332
Country	:	US
Telephone Number	:	919-851-3480
Fax Number	:	919-851-3381

Provider Business Practice Location Address
First Line	:	530 NEW WAVERLY PL
Second Line	:	SUITE 301
City	:	CARY
State	:	NC
Zip	:	27511-7414
Country	:	US
Telephone Number	:	919-851-3480
Fax Number	:	919-851-3381

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GREGORY JOSEPH BRANNON
Credential	:	M.D.
Telephone Number	:	919-851-3480

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	06/25/2012

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