Provider Demographics
NPI:1346623964
Name:FALK, BRANDON REID
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:REID
Last Name:FALK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 LINCOLN RD
Mailing Address - Street 2:APT 68
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3120
Mailing Address - Country:US
Mailing Address - Phone:443-985-0345
Mailing Address - Fax:
Practice Address - Street 1:501 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-4336
Practice Address - Country:US
Practice Address - Phone:601-684-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor