Provider Demographics
NPI:1417967753
Name:FOUCH, BRANDY BROMAGEN (MD)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:BROMAGEN
Last Name:FOUCH
Suffix:
Gender:F
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 1347
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-5347
Mailing Address - Country:US
Mailing Address - Phone:859-498-5243
Mailing Address - Fax:859-498-5396
Practice Address - Street 1:401 COMMERCE CIR
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-7815
Practice Address - Country:US
Practice Address - Phone:859-498-5243
Practice Address - Fax:859-498-5396
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39940208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics