Provider Demographics
NPI:1497190946
Name:QUEEN, BRANNON LINLEY (MD)
Entity Type:Individual
Prefix:
First Name:BRANNON
Middle Name:LINLEY
Last Name:QUEEN
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:PO BOX 161180
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-1180
Mailing Address - Country:US
Mailing Address - Phone:904-388-6949
Mailing Address - Fax:904-388-1841
Practice Address - Street 1:55530 HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:VANDIVER
Practice Address - State:AL
Practice Address - Zip Code:35176-7352
Practice Address - Country:US
Practice Address - Phone:205-934-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL351082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology