Provider Demographics
NPI:1033169073
Name:CARR, BRANDON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:CARR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 STEINER ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2574
Mailing Address - Country:US
Mailing Address - Phone:510-735-7190
Mailing Address - Fax:510-735-7190
Practice Address - Street 1:541 STEINER ST APT 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2574
Practice Address - Country:US
Practice Address - Phone:510-735-7190
Practice Address - Fax:510-735-7190
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18557363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA18557OtherPA-C LICENSE NUMBER