Provider Demographics
NPI:1083710610
Name:PRICE, BRANDON J (DO)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:J
Last Name:PRICE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-0997
Mailing Address - Country:US
Mailing Address - Phone:701-667-4600
Mailing Address - Fax:701-530-3780
Practice Address - Street 1:2500 SUNSET DRIVE NW
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58554
Practice Address - Country:US
Practice Address - Phone:701-667-4600
Practice Address - Fax:701-530-3780
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10971207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1452884Medicaid
NDN713808Medicare PIN
I60244Medicare UPIN
NDN713808Medicare PIN
ND14888Medicaid
NDP00767209OtherRR MEDICARE
MN352430100Medicaid