Provider Demographics
NPI:1235126186
Name:BRANNAN, PAUL ANDERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANDERSON
Last Name:BRANNAN
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 1:5310 CLARK RD
Mailing Address - Street 2:STE 106
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3228
Mailing Address - Country:US
Mailing Address - Phone:941-921-0400
Mailing Address - Fax:941-870-1628
Practice Address - Street 1:5310 CLARK RD
Practice Address - Street 2:STE 106
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3228
Practice Address - Country:US
Practice Address - Phone:941-921-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076811207W00000X
FLME1021852086S0122X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000278292OtherBCBS FACET NUMBER
KY64038763Medicaid
OH2307104Medicaid
IN10000440Medicaid
KY0656016Medicare PIN
OH4103322Medicare PIN
IN10000440Medicaid
OH4103326Medicare PIN
OH4103325Medicare PIN
IN173010KMedicare PIN
OH2307104Medicaid