Provider Demographics
NPI:1265443436
Name:BRANDON, RICHARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
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 1:490 FORDTOWN RD
Mailing Address - Street 2:
Mailing Address - City:FALL BRANCH
Mailing Address - State:TN
Mailing Address - Zip Code:37656-1900
Mailing Address - Country:US
Mailing Address - Phone:423-534-1382
Mailing Address - Fax:
Practice Address - Street 1:490 FORDTOWN RD
Practice Address - Street 2:
Practice Address - City:FALL BRANCH
Practice Address - State:TN
Practice Address - Zip Code:37656-1900
Practice Address - Country:US
Practice Address - Phone:423-534-1382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005617677Medicaid
TN3023011Medicaid
TNB58961Medicare UPIN
TN3023016Medicare PIN
VA005617677Medicaid