Provider Demographics
NPI:1114911534
Name:BRANNEN, ADELIA (MD)
Entity Type:Individual
Prefix:
First Name:ADELIA
Middle Name:
Last Name:BRANNEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BLOSSOM ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4243
Mailing Address - Country:US
Mailing Address - Phone:281-724-0190
Mailing Address - Fax:832-632-2415
Practice Address - Street 1:250 BLOSSOM ST STE 100
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4243
Practice Address - Country:US
Practice Address - Phone:281-724-0190
Practice Address - Fax:832-632-2415
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060040008OtherRAILROAD MEDICARE
TX86Z062OtherBCBS
TX4265026OtherAETNA
TX121330802Medicaid
TX87576ZOtherHMO BLUE
TX86Z062OtherBCBS
TX060040008OtherRAILROAD MEDICARE