Provider Demographics
NPI:1346460367
Name:SKELTON, BRANDON W (MD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:W
Last Name:SKELTON
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:PO BOX 2285
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835-2285
Mailing Address - Country:US
Mailing Address - Phone:662-507-2444
Mailing Address - Fax:
Practice Address - Street 1:611 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9321
Practice Address - Country:US
Practice Address - Phone:662-821-1837
Practice Address - Fax:662-680-5103
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN467062085R0202X
MS213032085R0202X
VA0116018271390200000X
VA01012407812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03755729Medicaid
TN1524269Medicaid
MS302I302430OtherMEDICARE MS
TN103I030258OtherMEDICARE TN
TN4300595OtherBCBS/TN
TN1524269Medicaid