Provider Demographics
NPI:1376500108
Name:CHISM, BRANDON S (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:S
Last Name:CHISM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3211 N NORTHHILLS BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4007
Mailing Address - Country:US
Mailing Address - Phone:479-571-4338
Mailing Address - Fax:479-571-4015
Practice Address - Street 1:3211 N NORTHHILLS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4007
Practice Address - Country:US
Practice Address - Phone:479-571-4338
Practice Address - Fax:479-571-4015
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ35183207RC0000X
ARE-4651207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00381947OtherRAILROAD MEDICARE
AZ090498Medicaid
ARE-4651OtherSTATE MEDICAL LICENSE
AZ090498Medicaid
AZZ109730Medicare PIN