Provider Demographics
NPI:1144214677
Name:CLINT, BRANDON (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:CLINT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:377 TH MEDICAL GROUP
Mailing Address - Street 2:2050A SECOND STREET SE
Mailing Address - City:KIRTLAND AFB
Mailing Address - State:NM
Mailing Address - Zip Code:87117-5522
Mailing Address - Country:US
Mailing Address - Phone:505-846-2193
Mailing Address - Fax:
Practice Address - Street 1:377 TH MEDICAL GROUP
Practice Address - Street 2:2050A SECOND STREET SE
Practice Address - City:KIRTLAND AFB
Practice Address - State:NM
Practice Address - Zip Code:87117-5522
Practice Address - Country:US
Practice Address - Phone:505-846-2193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1934207R00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine