Provider Demographics
NPI:1447239389
Name:BRANNICK, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:BRANNICK
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 1:2006 FRANKLIN ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4537
Mailing Address - Country:US
Mailing Address - Phone:256-539-0457
Mailing Address - Fax:256-539-5827
Practice Address - Street 1:2006 FRANKLIN ST SE
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4551
Practice Address - Country:US
Practice Address - Phone:256-539-0457
Practice Address - Fax:256-539-5827
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1243042085R0202X
TNMD341422085R0202X
AL349282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL183331Medicaid
AL184445Medicaid
AL265947Medicaid
FLI50MMOtherBCBS
AL183164Medicaid
AL183230Medicaid
AL213891Medicaid
300131093OtherRAILROAD MEDICARE
4042333OtherBCBS
FLIG582XOtherMEDICARE PTAN
AL266064Medicaid
FL015118000Medicaid
AL239945Medicaid
TN3870864Medicaid
KY000000269739OtherANTHEM BCBS
AL266065Medicaid
FLIG582ZOtherMEDICARE PTAN
AL183226Medicaid
AL183315Medicaid
AL183318Medicaid
FLIG582YOtherMEDICARE PTAN
AL266527Medicaid