Provider Demographics
NPI:1225025380
Name:BRANDON, ALFRED HERBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:HERBERT
Last Name:BRANDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:6030 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-7964
Practice Address - Country:US
Practice Address - Phone:954-322-7200
Practice Address - Fax:954-322-7203
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 418132085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8506999OtherCIGNA
FL9714OtherDIMENSION
FL5617106OtherAETNA
FL1235675OtherWELLCARE
FLP01652208OtherRR MEDICARE
FLP1015358OtherFREEDOM
FLP954201OtherOPTIMUM
FL040226500Medicaid
FL210538OtherAVMED
FL62444VMedicare PIN
FL210538OtherAVMED
FL1235675OtherWELLCARE
FL62444UMedicare PIN