Provider Demographics
NPI:1225017239
Name:BRANDON, STEVEN CARMICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CARMICHAEL
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 1:501 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2158
Mailing Address - Country:US
Mailing Address - Phone:662-323-3162
Mailing Address - Fax:662-323-1711
Practice Address - Street 1:501 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2158
Practice Address - Country:US
Practice Address - Phone:662-323-3162
Practice Address - Fax:662-323-1711
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115386Medicaid
MS010044039OtherRAILROAD MEDICARE
MS010044039OtherRAILROAD MEDICARE
MS080001495Medicare ID - Type Unspecified