Provider Demographics
NPI:1275922445
Name:HOLBERT, BRANDON (RVT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:HOLBERT
Suffix:
Gender:M
Credentials:RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SAN MATEO CT
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-4509
Mailing Address - Country:US
Mailing Address - Phone:817-805-4001
Mailing Address - Fax:
Practice Address - Street 1:310 SAN MATEO CT
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4509
Practice Address - Country:US
Practice Address - Phone:817-805-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153257OtherLICENSE