Provider Demographics
NPI:1033340740
Name:BRANCH, PAUL KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KENNETH
Last Name:BRANCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:380 EMPIRE RD
Mailing Address - Street 2:#120
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2677
Mailing Address - Country:US
Mailing Address - Phone:866-477-1169
Mailing Address - Fax:800-593-2559
Practice Address - Street 1:380 EMPIRE RD
Practice Address - Street 2:#120
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2677
Practice Address - Country:US
Practice Address - Phone:866-477-1169
Practice Address - Fax:800-593-2559
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY234976207Q00000X
WI41314-020207Q00000X
CODR 0052085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine