Provider Demographics
NPI:1053492645
Name:BRAND, WOODROW WILSON III (MD)
Entity Type:Individual
Prefix:DR
First Name:WOODROW
Middle Name:WILSON
Last Name:BRAND
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:10996 FOUR SEASONS PL
Mailing Address - Street 2:STE 100A
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8685
Mailing Address - Country:US
Mailing Address - Phone:662-256-8479
Mailing Address - Fax:662-256-1177
Practice Address - Street 1:806 EARL FRYE BLVD
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821
Practice Address - Country:US
Practice Address - Phone:662-256-8479
Practice Address - Fax:662-256-1177
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2019-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS12093208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009306530Medicaid
MS0111887Medicaid