Provider Demographics
NPI:1346413358
Name:TILLEY, BRANDON KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:KEITH
Last Name:TILLEY
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 1:5326 OAK ST
Mailing Address - Street 2:P.O. BOX 487
Mailing Address - City:SAINT FRANCISVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70775-4510
Mailing Address - Country:US
Mailing Address - Phone:225-635-5848
Mailing Address - Fax:225-635-5847
Practice Address - Street 1:5326 OAK ST
Practice Address - Street 2:
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775-4510
Practice Address - Country:US
Practice Address - Phone:225-635-5848
Practice Address - Fax:225-635-5847
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA205178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine