Provider Demographics
NPI:1487629762
Name:BRANDENBERG, GREGORY ALAN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:BRANDENBERG
Suffix:
Gender:M
Credentials:MD, PHD
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 3014
Mailing Address - Street 2:1015 DUFF AVE MCFARLAND CLINIC, PC
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-4468
Mailing Address - Fax:515-663-8683
Practice Address - Street 1:1015 DUFF AVE
Practice Address - Street 2:MCFARLAND CLINIC, PC
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3014
Practice Address - Country:US
Practice Address - Phone:515-239-4468
Practice Address - Fax:515-663-8683
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-5970-B207T00000X
IA38061207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1487629762Medicaid
IA1487629762Medicaid
IA1487629762Medicare PIN