Provider Demographics
NPI:1083492136
Name:LOFTIS, BRANDON MAURICE
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:MAURICE
Last Name:LOFTIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 BENMAR DR STE 1085
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3252
Mailing Address - Country:US
Mailing Address - Phone:346-394-2208
Mailing Address - Fax:
Practice Address - Street 1:440 BENMAR DR STE 1085
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3252
Practice Address - Country:US
Practice Address - Phone:346-394-2208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0000000146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic