Provider Demographics
NPI:1437669694
Name:MCMAHAN, BRANDON GEORGE (IDC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:GEORGE
Last Name:MCMAHAN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10172 KEPPLER DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2504
Mailing Address - Country:US
Mailing Address - Phone:561-628-8901
Mailing Address - Fax:
Practice Address - Street 1:10172 KEPPLER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2504
Practice Address - Country:US
Practice Address - Phone:561-628-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider