Provider Demographics
NPI:1114992070
Name:BRANDON, JOHN E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:BRANDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27340 HIGHWAY 86
Mailing Address - Street 2:
Mailing Address - City:GORDO
Mailing Address - State:AL
Mailing Address - Zip Code:35466
Mailing Address - Country:US
Mailing Address - Phone:205-364-7135
Mailing Address - Fax:205-364-8244
Practice Address - Street 1:27340 HIGHWAY 86
Practice Address - Street 2:
Practice Address - City:GORDO
Practice Address - State:AL
Practice Address - Zip Code:35466
Practice Address - Country:US
Practice Address - Phone:205-364-7135
Practice Address - Fax:205-364-8244
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000015657Medicaid
AL51015657OtherBLUE CROSS BLUE SHIELD
AL000015657Medicare ID - Type Unspecified
AL51015657OtherBLUE CROSS BLUE SHIELD