Provider Demographics
NPI:1285859645
Name:WEBB, BRANDON HUGH (DO)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:HUGH
Last Name:WEBB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-0030
Mailing Address - Country:US
Mailing Address - Phone:606-638-1154
Mailing Address - Fax:606-638-4502
Practice Address - Street 1:2673 HIGHWAY 644
Practice Address - Street 2:SUITE 2
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-5922
Practice Address - Country:US
Practice Address - Phone:606-638-3323
Practice Address - Fax:606-638-3325
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03165207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1285859645Medicaid
WV1285859645OtherBCBS WV
WV1285859645OtherBCBS WV